肺黏膜相关淋巴组织淋巴瘤临床特征及预后分析

  目的  分析肺黏膜相关淋巴组织（MALT）淋巴瘤的发病情况、临床病理特征、影像学表现和治疗、预后情况,探讨肺MALT淋巴瘤诊治中的相关问题。  方法  回顾性分析14例肺MALT淋巴瘤患者的临床资料、治疗反应及预后因素。  结果  14例肺MALT淋巴瘤患者发病年龄为33~73岁,平均发病年龄为（52.36±13.08）岁,高峰年龄段40~60岁,占50%。男女比例为1﹕1。其中92.86%（13/14）患者为Ⅰ~Ⅱ期病变,50.00%（7/14）患B症状,64.29%（9/14）有结外受累。2例患者行手术治疗,4例行利妥昔单抗联合化疗,3例患者行未含利妥昔单抗的化疗,1例患者行利妥昔单抗单药化疗,1例患者间断使用干扰素2年,3例患者未接受任何化疗。随访15~75个月,平均随访时间（37.86±19.52）个月,总生存率100%,总无进展生存率57.14%（8/14）。预后分析提示结外侵犯数≥2枚、Ann Arbor分期≥Ⅲ、血乳酸脱氢酶（LDH）、IgM水平升高为不良预后因素。  结论  肺MALT淋巴瘤是一种惰性淋巴瘤,进展缓慢,临床表现不典型,影像学改变缺乏特异性,诊断主要依靠病理活检。联合利妥昔单抗的免疫化疗效果好,可作为肺MALT淋巴瘤的标准治疗。      

滤泡型淋巴瘤患者临床特征及预后因素分析

目的:分析滤泡型淋巴瘤（follicular lymphoma,FL）患者的临床特征及预后因素。方法:对2006年至2016年115例经我院病理科确诊为FL患者进行回顾性病理及临床特征分析,其中62例住院诊治的患者中,30例接受含有利妥昔单抗方案的治疗,22例患者进行普通化疗,10例患者未行任何治疗,并随访观察。结果:62例患者中,利妥昔单抗联合化疗组和单用化疗组,2年OS率均为100%,5年OS率分别为90%和70%,OS间无显著性差异（P=0.332 5）。2年PFS率分别为94%和84%,5年PFS率分别为84%和49%,PFS间有显著性差异（P=0.025 3）。FLIPI-2预后分析,中危组中利妥昔单抗联合化疗与单用化疗组间2年PFS分别为100%、80%,有显著性差异（P=0.021 9）,低危组中利妥昔单抗联合化疗与单用化疗组间2年PFS分别为100%、95%,高危组中利妥昔单抗联合化疗与单用化疗组间2年PFS分别为92%、76%,低危组和高危组中利妥昔单抗联合化疗与单用化疗组相比PFS均无显著性差异。CD10表达阳性组的总反应率（37.14%）明显高于阴性组（22.86%）。结论:FL好发于60岁以下男性,结外病变少见,预后分层多为低危组。规律利妥昔单抗联合化疗可以进一步提高缓解率,延长生存期。     

R-CHOP与CHOP方案治疗初治弥漫大B细胞型淋巴瘤在中国的多中心随机对照研究

背景与目的:CHOP化疗方案是目前治疗弥漫性大B细胞型非霍奇金淋巴瘤(non-HodgkinTslymphoma,NHL)的标准方案。利妥昔单抗(美罗华)作为一种针对CD20抗原表达阳性的B细胞的嵌合型单克隆抗体,对弥漫性大B细胞型淋巴瘤具有良好的疗效。在欧洲和美国,利妥昔单抗联合标准化疗方案治疗进展型NHL已经获得批准。本研究旨在比较利妥昔单抗加标准CHOP方案与标准CHOP方案治疗中国人CD20阳性的弥漫大B细胞型NHL患者的疗效和安全性。方法:2003年9月至2004年11月在全国9个研究中心进行,共有63例患者入组,其中CHOP组32例,R-CHOP组31例。所有入组患者均签署并提供知情同意书。CHOP组患者接受每3周为1个疗程共6个疗程的CHOP方案治疗;R-CHOP组患者在每个疗程开始的第1天联用利妥昔单抗的CHOP治疗方案。比较两组的完全缓解率、总体缓解率以及不良反应情况。结果:R-CHOP组和CHOP组的完全缓解率相似(41.9%vs.37.5%,P=0.719),而总体缓解率前者要高于后者(83.8%vs.65.6%,P=0.096),但无显著性差异。治疗期间CHOP组有21.9%的患者疾病进展,而R-CHOP组仅为3.2%,两组有显著性差异(P=0.026)。R-CHOP组和CHOP组的不良反应发生率相似(65.6%vs.67.7%),差异无显著性(P=0.859)。最常见的不良反应均为白细胞下降;R-CHOP组其次常见不良反应是发热和寒战,可能与输注利妥昔单抗有关。两组的临床相关毒副作用相似,差异无显著性。结论:利妥昔单抗联合CHOP方案治疗CD20阳性的弥漫大B细胞型NHL与单纯CHOP方案相比,能显著降低治疗失败率,同时并不增加化疗的毒副反应。     

恶性血液病治疗中并发带状疱疹的临床分析

目的探讨恶性血液病治疗过程中并发带状疱疹（HZ）的高危因素和疗效。方法回顾性分析2009年6月至2012年3月河南省肿瘤医院血液科恶性血液肿瘤患者HZ的发病情况、临床特点和疗效以及原发病治疗情况。结果624例恶性血液病患者中，23例发生HZ，其中淋巴系统恶性肿瘤21例，骨髓增生异常综合征2例；中位发病时间为化疗后270d（0～450d），化疗后1年内的发病率为95．65％（22／23）。临床主要表现为区域性皮肤疱疹和神经性疼痛，2例出现严重的神经痛。除1例出现颅脑侵犯，其他均无内脏受累。23例患者接受以阿昔洛韦为主的治疗，中位治疗时间为12d（5d～240d），22例治愈，1例发生疱疹相关性死亡。23例患者中13例接受糖皮质激素治疗，分别有2、6和6例患者接受利妥昔单抗、氟达拉滨和硼替佐米治疗。结论淋巴系统恶性肿瘤患者易发生HZ，化疗后1年内是发病高峰期。高龄和应用糖皮质激素、利妥昔单抗、氟达拉滨和硼替佐米药物化疗是发生HZ的高危因素。阿昔洛韦治疗HZ疗效好。     

利妥昔单抗时代放疗对早期韦氏环弥漫大B细胞淋巴瘤的作用价值

目的 分析早期韦氏环弥漫大B细胞淋巴瘤接受利妥昔单抗加CHOP为主方案化疗后放疗的作用价值。方法 2000—2013年收治83例确诊为原发韦氏环弥漫大B细胞淋巴瘤患者,其中Ⅰ期25例、Ⅱ期58例。全组接受了利妥昔单抗加CHOP为主方案化疗,62例接受了受累野放疗(韦氏环+颈部淋巴结区域),21例未接受放疗。Kaplan-Meier法计算OS、PFS、LRC并Logrank法检验和单因素分析,Cox模型多因素分析。结果 全组5年样本数18例,5年OS、PFS和LRC率分别为89%、84%和90%。单因素分析显示年龄>60岁、LDH升高、ECOG≥2分和IPI≥2分是OS的预后不良因素。年龄>60岁、肿瘤≥5 cm、ECOG≥2分和IPI≥2分是PFS和LRC的影响因素。在利妥昔单抗治疗基础上加入巩固性放疗比未放疗者提高了5年PFS、LRC,分别为94%比58%(P=0.003)、100%比61%(P=0.000),OS有增加趋势(94%比71%,P=0.063)。结论 早期韦氏环弥漫大B细胞淋巴瘤利妥昔单抗加CHOP为主方化疗后巩固性放疗显著改善了PFS、LRC率,并可能改善OS率,需大样本和前瞻性研究证实。     

利妥昔单抗联合化疗治疗复发B细胞恶性淋巴瘤的回顾性分析

目的:探讨含利妥昔单抗(美罗华)方案在复发B细胞性淋巴瘤治疗中的效果,同时分析影响疗效的相关因素.方法:回顾性总结我院用利妥昔单抗单药或联合化疗对复发B细胞恶性淋巴瘤患者的疗效及不良反应和影响因素.结果:20例可评价疗效的患者中2例用利妥昔单抗单药,利妥昔单抗联合化疗者18例,总有效率(RR)70%(14/20),完全缓解率(CR)20%(4/20).中位总生存期是17.5个月,1年、2年及3年的总生存率分别是68%、45%和32%;中位无进展生存期是11.5个月,1、2、3年的无进展生存率分别是55%、32%和23%.疗效与临床分期、IPI评分、结外侵犯有关,与其他因素无明显相关.榆注利妥昔单抗后主要不良反应为畏寒、发热乏力等输注相关反应.结论:利妥昔单抗应用于复发B细胞性淋巴瘤疗效高,不良反应可以耐受.     

利妥昔单抗联合化疗治疗弥漫型大B细胞淋巴瘤的临床观察

目的: 探讨利妥昔单抗联合化疗治疗弥漫型大B细胞淋巴瘤患者的临床疗效和安全性.方法: 回顾性分析100例病理确诊为弥漫型大B细胞淋巴瘤患者的临床资料.所有患者均接受2～8次的利妥昔单抗治疗,利妥昔单抗的平均治疗次数为5.8次.同时,所有患者均接受了化疗.评价疗效和不良反应.结果: 100例患者中达完全缓解者46例(46%).达部分缓解者37例(37%),总有效率(完全缓解+部分缓解)为83%(83/100).红细胞沉降率、国际预后指数评分、是否为初治患者、B症状以及利妥昔单抗治疗周期数对疗效有显著影响(P<0.05),而性别、年龄、原发部位和功能状态评分对疗效无影响(P>0.05).1、2、3和5年生存率分别为87.5%、72.8%、60.8%和60.8%.COX回归模型多因素分析发现,国际预后指数评分、利妥昔单抗治疗周期数和治疗后的疗效对生存的影响有统计学意义(P<0.05).100例患者中共有11例因静脉输注利妥昔单抗而发生输液不良反应.结论: 利妥昔单抗联合化疗治疗弥漫型大B细胞淋巴瘤的临床缓解率较高,患者酎受良好且生存时间较长.     

R-CHOP方案治疗脾边缘区B细胞淋巴瘤一例并文献复习

  目的　探讨老年脾边缘区淋巴瘤（SMZL）患者的最佳治疗途径。方法　对R-CHOP方案治疗的1例SMZL进行病例分析并复习相关文献。结果　患者经2个周期R-CHOP方案化疗达完全缓解,原方案巩固治疗4个周期,序贯利妥昔单抗维持治疗2年,病情仍呈缓解状态。几项回顾性研究显示利妥昔单抗治疗SMZL 3年无进展生存（PFS）明显优于单纯脾切除及单用化疗。结论　利妥昔单抗联合或不联合化疗,可能成为老年初治SMZL患者的最佳选择,脾切除联合利妥昔单抗适合单抗治疗无效的患者。     

利妥昔单抗联合化疗治疗霍奇金淋巴瘤一例并文献复习

 【摘要】　目的　分析利妥昔单抗联合化疗方案治疗霍奇金淋巴瘤（HL）的疗效。方法　采用利妥昔单抗联合ABVD方案治疗1例经典型HL（cHL）并复习文献。结果　HL组织中有CD+20 表达,结节性淋巴细胞为主型表达率98 %～100 %,经典型表达率18 %～32 %。RS干细胞中亦有CD+20 表达。利妥昔单抗针对CD+20 细胞,清除RS细胞,抑制RS干细胞及反应性背景B细胞,阻断肿瘤细胞存活信号。利妥昔单抗单药治疗的临床反应率在结节性淋巴细胞为主型83 %～100 %,经典型22 %;与化疗联合应用,明显延长病情缓解期,提高治疗反应率。临床Ⅱ期观察利妥昔单抗联合ABVD方案治疗cHL患者,完全缓解率达81 %～93 %,5年无瘤生存率及总体生存率分别为83 %和96 %。该例患者治疗获得缓解,随访1年,健康生存。结论　利妥昔单抗联合化疗治疗HL安全有效。     

含利妥昔单抗方案治疗EB病毒相关嗜血细胞性淋巴组织细胞增多症六例临床分析

目的：观察含利妥昔单抗方案治疗EB病毒相关嗜血细胞性淋巴组织细胞增多症（EBV-HLH）的效果。方法回顾性分析6例接受含利妥昔单抗方案治疗的EBV-HLH患者的临床资料,随后确诊为淋巴瘤相关及原发性HLH患者未纳入分析。结果6例EBV-HLH患者均为男性,年龄20～61岁,中位年龄27.5岁（21～60岁）。2例初治EBV-HLH患者治疗后2周达到部分缓解,但均在4周内复发;4例复发EBV-HLH患者均未缓解。6例EBV-HLH患者最终均因原发病进展、合并出血或感染等死亡。利妥昔单抗治疗前1周和治疗后1～2周白细胞、血红蛋白、血小板、铁蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、纤维蛋白原和EBV-DNA共9项指标差异均无统计学意义（均P＞0.05）。结论含利妥昔单抗方案治疗EBV-HLH的疗效不及既往研究结果,有待于前瞻性大规模利妥昔单抗单药治疗EBV-HLH的临床试验进一步验证。     

Cell-mediated immunity to varicella zoster virus in children being treated for cancer.

Stimulation of lymphocytes by varicella-zoster virus (VZV) antigen was measured in vitro for 37 healthy adults and children and for 35 children who developed herpes zoster or varicella while receiving anticancer therapy. For 35 of the control group the history of varicella infection correlated with the in vitro response of lymphocytes to VZV antigen. A specific lymphocyte response was observed following 32 of the 37 episodes of VZV infection in the 35 children with malignancy. Re-evaluation 7--12 months following the acute infection revealed that the in vitro response to VZV antigen was lost in six of 19 patients who remained in remission and in all patients who relapsed and received reinduction therapy. Although there was some suggestion that development of a cell mediated response early in the infection decreased the incidence of skin dissemination of the virus in herpes zoster, no consistent correlation could be made between lymphocyte responsiveness in vitro and dissemination of disease or the duration of the appearance of new lesions.     

Filgrastim helps to heal herpes zoster faster: two case reports

Herpes zoster is an infectious disease caused by varicella-zoster virus that may occur sporadically at any age. We report on two patients with herpes zoster who received chemotherapy for breast cancer. Both patients were immunocompromised and received filgrastim therapy for the management of neutropenia. Zoster occurred during filgrastim therapy but the symptoms were alleviated rapidly in the course of therapy. We conclude that granulocyte colony-stimulating factor therapy helped symptom alleviation and accelerated the recovery from herpes zoster in our chemotherapy-treated patients.     

三氧化二砷治疗血液病后合并带状疱疹的临床研究

 目的　分析三氧化二砷（ATO）治疗血液病后合并带状疱疹感染患者的临床特征及其可能的发生机制。方法　将研究对象分为研究组（应用ATO）和对照组（未应用ATO）,观察两组带状疱疹发病率,以及研究组中发生带状疱疹和未发生带状疱疹患者的平均化疗次数。结果　研究组带状疱疹发病率为23.95 %（23／96）,发生带状疱疹者平均化疗7.60次,未发生带状疱疹者平均化疗7.72次（Z＝0.976,P＝0.296）;对照组带状疱疹发病率7.89 %（3／38）,两组间带状疱疹发病率差异有统计学意义（χ2＝4.492,P＝0.034）。结论　ATO治疗血液疾病可以增加带状疱疹的发病率,可能与其激活水痘-带状疱疹病毒有关。     

Rituximab-related viral infections in lymphoma patients

Recently, a human/mouse chimeric monoclonal antibody, rituximab, has been successfully used to treat cases of B-cell non-Hodgkin's lymphoma and some autoimmune diseases. However, several viral infections related to rituximab have been reported in the literature, but were not well characterized. To further investigate this topic, relevant English language studies were identified through Medline. There were 64 previously reported cases of serious viral infection after rituximab treatment. The median age of the cases was 61 years (range: 21 - 79). The median time period from the start of rituximab treatment to viral infection diagnosis was 5.0 months (range: 1 - 20). The most frequently experienced viral infections were hepatitis B virus (HBV) (39.1%, n = 25), cytomegalovirus infection (CMV) (23.4%, n = 15), varicella-zoster virus (VZV) (9.4%, n = 6), and others (28.1%, n = 18). Of the patients with HBV infections, 13 (52.0%) died due to hepatic failure. Among the 39 cases that had viral infections other than HBV, 13 died due to these specific infections. In this study, about 50% of the rituximab-related HBV infections resulted in death, whereas this was the case in only 33% of the cases with other infections. Close monitoring for viral infection, particularly HBV and CMV, in patients treated with rituximab should be recommended.     

Bortezomib and the increased incidence of herpes zoster in patients with multiple myeloma

BackgroundBortezomib has significantly advanced the treatment of patients with multiple myeloma (MM). However, considering that most patients with MM are elderly, bortezomib-related morbidity should be thoroughly studied to ensure the safe use of this drug. Herpes zoster has been reported as a possible adverse event associated with bortezomib because a major target of bortezomib, nuclear factor—κB, is known to be involved with T-cell immunity.Patients and MethodsWe performed a retrospective analysis of the incidence of herpes zoster among 282 patients treated with a bortezomib-containing regimen.ResultsDuring the patients' pre-bortezomib treatment (median, 2.14 years), the incidence of herpes zoster was 11% (31 of 282 patients). However, after the patients were treated with bortezomib, the incidence increased to 22.3% (63 of 282 patients), of which almost all occurrences were within the first 3 cycles (median duration, 41 days). The time interval from diagnosis to bortezomib initiation date was shorter in herpes zoster—positive patients than in herpes zoster—negative patients (2.14 ± 1.87 years vs. 3.38 ± 2.95 years; P = .002). Disease duration, previous herpes zoster infection, disease stage and type of myeloma, and the type and intensity of previous treatments failed to show any relationship with herpes zoster. These findings suggest that longer history of disease and treatments did not affect the occurrence of herpes zoster, nor did the type of bortezomib regimens or their toxicities.ConclusionBortezomib can increase the incidence of herpes zoster regardless of disease duration, previous treatments, and concomitantly administered drugs. Thus, the occurrence of herpes zoster should be monitored during bortezomib treatment.     

Infectious complications in chronic lymphoid malignancy

Opinion statement Taking steps to minimize, prevent, and treat infection in patients with chronic lymphoid malignancies, especially chronic lymphocytic leukemia, has always been a challenge. As more patients with these diseases live longer and lead productive lives upon successful initial treatment, strategies for preventing infections havebecome more important. Distinguishing patients at low risk for infection from those at high risk is a crucial but challenging issue. Unfortunately, there are hardly any data on the use of prophylactic antibiotics for patients with chronic lymphoid malignancy (CLL). If patients cannot be enrolled in a clinical trial, antibiotics with co-trimoxazole should be administered when steroids are warranted. They should also be administered in patients who have had a documented infection early in the treatment course and during neutropenia. Viral infections remain another controversial issue in patients with CLL receiving treatment, especially a purine analogue. Very low CD4 counts (less than 50 cells/mL) might predict for reactivation for herpes zoster. Outside of depleted CD4 counts, there are no other means of identifying a high-risk group. Based on limited data, it would be reasonable to administer herpes zoster prophylaxis to patients with CD4 counts that are severely depleted or to patients with a prior episode of zoster. Controversial issues still remain regarding immunoglobulin treatment, specifically cost, scarcity of the product, and adequate dose, which has not yet been established. We would consider intravenous immunoglobulin (Ig) replacement in patients with marked hypogammaglobulinemia IgG less than 400 mg/dL with more than two recent severe infections [1]. Lower Ig doses 240 mg/kg have been shown to be equivalent to higher ones in this trial [1].     

Interferon in skin diseases

In the dermatological field, interferon is used in clinical trials for viral skin diseases and for malignant skin tumors such as malignant melanoma. In regard to viral diseases, clinical trials have shown promising results in viral warts, herpes simplex and herpes zoster. In the double-blind trial, patients with bilateral common warts of the extremities were treated at weekly intervals with intralesional injections of either human fibroblast interferon or placebo. More than 81% of the interferon-treated extremities were either cured by or responded effectively to the therapy, while only 17% of the placebo responded. Although our data has confirmed that interferon is effective in the treatment of common warts diseases, the method of application and repeated injections indicate that this therapy may not be helpful in routine cases but only in selected patients in whom other therapy has failed. However, development of new delivery systems or modification of dosages may increase the value of interferon therapy for warts disease. Interferon seems also effective for herpes zoster. But herpes zoster usually regresses spontaneously within three weeks, therefore, it is not easy to define efficacy of interferon in this disease. Therefore, we need to examine the effect of interferon on herpes zoster both in placebo controlled and double-blind trials involving patients with immunocompromised diseases.     

Decrease in CD4+ T-Cell Counts in Patients With Multiple Myeloma Treated With Bortezomib

BackgroundBortezomib is highly effective in multiple myeloma and is widely used in this disease. Recently, an increased incidence of varicella zoster virus (VZV) reactivation was reported in patients with myeloma undergoing bortezomib treatment.Patients and MethodsWe investigated the influence of bortezomib on T-cell subpopulations in 53 patients with myeloma before initiation of bortezomib and during therapy.ResultsA decrease of CD4+ T cells was seen in 41 of 53 patients (77%). The median CD3+/CD4+ lymphocyte counts declined from 494/μL (range, 130-2187/μL) to 274/μL (range, 41-1404/μL) during bortezomib treatment (P < .001). In the majority of patients (40 of 53 patients, 75%), CD4+ lymphocytes dropped to < 400/μL during bortezomib treatment, and in 18 of 53 patients (33.9%) the CD4+ T cells fell below 200/μL. The minimum CD4+ cell count was observed at a median of 6 weeks (range, 2-22 weeks) after initiation of treatment. The incidence of herpes zoster reactivation was 5.7% in the whole population of patients with myeloma receiving bortezomib. Nineteen of 53 patients received acyclovir at a dose of 400 mg daily as prophylaxis against VZV reactivation. In this group, none of the patients developed herpes zoster. The incidence of VZV reactivation in patients not receiving acyclovir was 3 of 34 (8.8%). Importantly, occurrence of herpes zoster was associated with reduced CD4+ T-cell subpopulation: all patients who developed herpes zoster had CD4+ lymphocytes < 400/μL.ConclusionOur results show that bortezomib leads to a transient decrease in CD4+ lymphocytes, accompanied by an increased incidence of VZV infections. The antiviral prophylaxis with acyclovir is effective in patients with myeloma treated with bortezomib.     

A randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients

In this randomized, double-blind, multicenter, acyclovir-controlled study, the efficacy and safety of famciclovir were evaluated for the treatment of herpes zoster in patients who were immunocompromised following bone marrow or solid organ transplantation or oncology treatment. A total of 148 patients, 12 years or older with clinical evidence of localized herpes zoster, received either oral famciclovir, 500 mg three times daily, or acyclovir, 800 mg five times daily, for 10 days. Famciclovir was equivalent to acyclovir with respect to the numbers of patients reporting new lesion formation while on therapy (77% vs. 73%, respectively). There were no significant differences between the groups in the time to cessation of new lesion formation, full crusting, complete healing of lesions, or loss of acute phase pain. Treatment with famciclovir was well tolerated, with a safety profile comparable to that of acyclovir. Thus oral famciclovir is a convenient, effective, and well-tolerated regimen for immunocompromised patients with herpes zoster.     

硼替佐米联合沙利度胺和地塞米松方案序贯造血干细胞移植治疗初治多发性骨髓瘤的临床观察

目的探讨硼替佐米联合方案序贯造血干细胞移植治疗初治多发性骨髓瘤的疗效和相关毒副作用。方法选取2006年6月至2014年4月初治多发性骨髓瘤33例为研究对象,采用硼替佐米+沙利度胺+地塞米松(BTD)方案诱导治疗(2⁷个疗程),其中14例继以马法兰预处理后行造血干细胞移植;所有患者均接受沙利度胺+地塞米松(TD)或来那度胺+地塞米松(LD)方案维持治疗。随访57个疗程),其中14例继以马法兰预处理后行造血干细胞移植;所有患者均接受沙利度胺+地塞米松(TD)或来那度胺+地塞米松(LD)方案维持治疗。随访5⁹2个月,观察疗效及不良反应。结果 BTD方案诱导治疗后获得完全缓解(CR)、很好的部分缓解(VGPR)、部分缓解(PR)的例数分别为8例(24.2%)、11例(33.3%)、12例(36.4%),总有效率(ORR)为94.0%。14例移植患者中,移植后获VGPR 9例,单用BTD组和序贯移植组的中位随访时间分别为51和32个月,中位生存时间尚未获得,预期3年无进展生存率分别为42.3%和58.7%。BTD方案的不良反应主要为血细胞减少、周围神经病变、带状疱疹病毒感染、便秘、感染和乏力等,大多数患者给予对症治疗后可耐受。结论以硼替佐米联合诱导治疗并以造血干细胞移植序贯治疗多发性骨髓瘤,毒副反应可耐受,疗效显著,生存期较长。