低剂量沙利度胺联合VAD方案治疗多发性骨髓瘤25例

 目的　探讨低剂量沙利度胺联合VAD方案治疗多发性骨髓瘤（MM）的疗效及不良反应。方法　确诊的MM患者25例，沙利度胺100 mg／d，每晚睡前口服；VAD方案：长春新碱0.5 mg／d静脉滴注，第1天至第4天，多柔比星10 mg／d静脉滴注，第1天至第4天，地塞米松40 mg／d口服，第1天至第4天、第9天至第12天、第17天至第20天，每月1个疗程，共6个疗程。结果　21例患者完成了6个疗程，完全缓解5例（23.8 %），部分缓解14例（66.7 %），未缓解2例（9.5 %），总有效率90.5 %。沙利度胺的主要不良反应为乏力、便秘、水肿、末梢神经炎，对症处理后可耐受。结论　低剂量沙利度胺联合VAD方案治疗MM有效率高，且不良反应较低。     

小剂量沙利度胺治疗多发性骨髓瘤的临床观察

 目的 观察小剂量沙利度胺联合地塞米松和化疗治疗多发性骨髓瘤（MM）的疗效和毒副作用。方法 7例MM患者予沙利度胺口服,起始剂量50 mg／d ,至最大剂量50 ~ 300 mg,联合地塞米松或VAD方案化疗。结果 4例患者部分缓解（PR）,2例患者进步,1例患者无效,总有效率达85 %。毒副作用有嗜睡、乏力、便秘、皮疹、手足麻木,毒副反应轻。结论 小剂量沙利度胺联合地塞米松和化疗治疗MM是安全有效的。     

低剂量沙利度胺联合化疗治疗多发性骨髓瘤25例

目的观察低剂量沙利度胺联合化疗治疗多发性骨髓瘤（MM）的临床疗效。方法25例MM患者,给予沙利度胺100mg/d,同时联合MP或VAD方案化疗。在化疗疗程结束后继续给予沙利度胺100mg／d维持治疗6个月以上。结果部分缓解13例,进步7例,无效5例,有效率为52％,不良反应轻,均可耐受。结论低剂量沙利度胺联合化疗治疗MM安全有效。     

硼替佐米和沙利度胺联合VAD方案治疗多发性骨髓瘤疗效分析

目的探讨硼替佐米、沙利度胺联合VAD方案治疗多发性骨髓瘤（MM）的临床疗效。方法 18例初诊MM患者采用硼替佐米、沙利度胺联合VAD方案治疗（A组）,硼替佐米1.3 mg/m2,沙利度胺从100 mg/d开始口服,逐渐增加剂量,至200 mg/d。单纯使用VAD方案（B组）治疗的23例初诊MM患者作为对照组。结果 A组的治疗有效率优于B组（P〈0.05）,联合治疗组的不良反应有皮疹、便秘、神经毒性、乏力、嗜睡、脱发及感染。结论硼替佐米和沙利度胺联合VAD方案治疗MM疗效明显优于VAD方案,缓解率高,对于初诊性MM是疗效较好而又较安全的方案,在选择化疗方案时可优先考虑。     

小剂量沙利度胺联合地塞米松治疗多发性骨髓瘤临床观察

 目的　观察小剂量沙利度胺联合地塞米松治疗多发性骨髓瘤（MM）的临床疗效及其不良反应。方法　12例MM患者,其中包括9例难治复发和3例初发,沙利度胺100～200 mg／d口服,每28 d为1个周期, 共3个周期,同时联合小剂量地塞米松15 mg／d口服,第1天至第4天,第15天至第18天,每28 d为1个周期,至少治疗3个周期。结果　CR 3例,PR 5例,进步3例,无效1例;不良反应可耐受,轻度便秘及嗜睡多见。结论　小剂量沙利度胺联合地塞米松治疗MM安全、有效,患者耐受性好。     

以亚砷酸为主的四联疗法治疗难治性多发性骨髓瘤11例

目的观察亚砷酸联合维生素C、沙利度胺、小剂量地塞米松治疗难治性多发性骨髓瘤（MM）的疗效及不良反应。方法11例难治性MM患者,应用0．1％亚砷酸注射液10mg／d加入5％葡萄糖注射液500ml静脉滴注,亚砷酸静脉滴注结束15min后,维生素C3．0g加入5％葡萄糖注射液500ml静脉滴注,沙利度胺100～150mg／d,睡前顿服,地塞米松1．5mg／d,晨起顿服。连用14～21d为1个疗程。结果显效3例;进步4例;2例病情相对稳定,2例无效,总有效率63．6％,患者无不能耐受的不良反应。结论亚砷酸联合维生素C、沙利度胺、小剂量地塞米松治疗难治性MM具有药效协同、不良反应减小、疗效较高、耐受性好等优点,值得临床深入研究和推广应用。     

不同剂量地塞米松联合沙利度胺治疗多发性骨髓瘤

 目的　比较标准剂量地塞米松和小剂量地塞米松联合沙利度胺治疗多发性骨髓瘤（MM）的疗效和患者不良反应。方法　39例MM患者随机分成两组,均给予沙利度胺+地塞米松方案化疗,沙利度胺200 mg／d,标准剂量组给予地塞米松40 mg第1天至第4天,28 d,小剂量组予地塞米松20 mg第1天至第4天,28 d,共4个疗程。比较两组的疗效、生存情况和患者不良反应。结果　标准剂量组完全缓解5例（26.3 %）、部分缓解7例（35.0 %）、总有效率75.0 %,小剂量组完全缓解3例（15.8 %）、部分缓解7例（36.8 %）、总有效率68.4 %,两组差异无统计学意义（P＞0.05）,标准剂量组的肺部感染、血压升高、血糖升高、带状疱疹等不良反应均高于小剂量组,两组差异有统计学意义（P＜0.05）。结论　标准剂量组与小剂量组治疗MM疗效相近,但不良反应明显增多。     

沙利度胺联合地塞米松治疗初发多发性骨髓瘤的临床观察

 目的 观察沙利度胺联合地塞米松治疗初发多发性骨髓瘤（MM）的疗效。方法 沙利度胺100 mg／d,每周增加50 ~ 100 mg／d,直到200 ~ 300 mg／d,维持治疗。地塞米松40 mg／d,第1 ~ 4天,第9 ~ 12天,第17 ~ 20天,28 d为1疗程。获完全缓解或部分缓解的患者,应用沙利度胺100 ~ 200 mg／d维持,每2个月应用地塞米松40 mg／d,第1 ~ 4天,冲击治疗1次。结果 21例初发MM 5例达完全缓解,12例获部分缓解,总有效率80.9 %。结论 沙利度胺联合地塞米松治疗初发MM疗效较好     

亚砷酸联合沙利度胺治疗难治性复发性多发性骨髓瘤的疗效

 【摘要】　目的　观察亚砷酸（ATO）联合沙利度胺治疗难治性复发性多发性骨髓瘤（MM）的疗效和安全性。方法　35例难治性复发性MM患者,给予ATO（10 mg／d）及维生素C（2 g／d）静脉滴注,连续应用14 d,每28 d为1个疗程;同时给予沙利度胺口服,起始剂量为50 mg／d,1周后逐步加量并调整至100～150 mg／d,长期维持。连续应用3个疗程后评估疗效和患者不良反应,有效患者继续沙利度胺维持治疗,并随访观察无进展生存（PFS）。采用参照欧洲血液和骨髓移植小组骨髓瘤疗效判定标准判定疗效,并按世界卫生组织（WHO）标准判定不良反应。结果　ATO联合沙利度胺治疗难治性复发性MM总有效率71.43 %（25／35）,完全缓解2例（5.71 %）,部分缓解12例（34.29 %）,微小反应 11例（31.43 %）,无效10例（28.57 %）。25例患者进入维持治疗后,中位随访期为11个月（2～31个月）,中位PFS 9个月。主要不良反应有消化道反应、白细胞减少、肝功能损害、手足麻木等,不良反应轻微,均可耐受。结论　ATO联合沙利度胺治疗难治性复发性MM有效、可行,并有较好的治疗顺从性。     

沙利度胺联合地塞米松治疗难治复发性多发性骨髓瘤的临床研究

 目的 探讨沙利度胺联合地塞米松（Thal-Dex）方案治疗难治复发性多发性骨髓瘤（MM）的疗效及相关毒副作用。方法 采用Thal-Dex方案对15例难治复发性MM患者进行治疗，沙利度胺起始剂量为100 mg，维持两周后逐渐增至200 mg；地塞米松片40 mg口服，第1～4天、第9～12天、第17～20天，4周为1疗程；口服小剂量华法林（1.25 mg／d）预防深静脉血栓（DVT），监测骨髓细胞学浆细胞数、血M蛋白、血β2-微球蛋白及其他常规检查项目。结果 15例患者中完全缓解5例，部分缓解4例，微小反应4例，无反应1例，死亡1例，总体反应率为60.0 %；3例患者发生DVT；全部患者未发生Ⅱ级以上血液毒性。结论 Thal-Dex 方案对于难治复发性MM有较好的疗效，耐受性好，但需注意DVT发生。     

沙利度胺联合地塞米松诱导治疗初诊多发性骨髓瘤

背景与目的:沙利度胺是治疗复发、难治性多发性骨髓瘤(multiple myeloma,MM)的有效药物,但其在初诊MM诱导治疗中的作用仍不清楚.本研究目的是评价沙利度胺联合地塞米松(thalidomide and dexamethasone,TD)在初诊MM诱导治疗中的治疗效果和不良反应.方法:应用TD方案诱导治疗39例初诊MM.沙利度胺100～300 mg/d,持续口服;地塞米松20～40 mg/d,在奇数疗程的第1～4天、第9～12天和第17～20天口服;在偶数疗程的第1～4天使用,28天为1疗程.并以36例接受VAD方案诱导治疗的临床资料匹配的初诊MM作为历史对照,比较两组的疗效、生存情况和不良反应.结果:TD方案诱导治疗初诊MM的总有效率为71.8%,VAD组为61.1%(P＞0.05).TD组中位无疾病进展生存时间(progression-free survival,PFS)为14个月,VAD组的中位PFS为9个月,两组相比差异无统计学意义(P＞0.05).TD组的中位总生存时间(overall survival,OS)尚未达到,VAD组中位OS为29个月.TD组常见的不良反应有便秘、乏力、头晕、嗜睡等,多为2级以下.VAD组3级以上白细胞减少和血小板降低明显多于TD组(P＜0.05),各种感染的发生率也高于TD组(P＜0.05).结论:TD方案是对初诊MM有效的治疗方案,可以代替VAD方案作为初诊MM的诱导治疗方案.     

Low dose thalidomide in patients with relapsed or refractory multiple myeloma

Remarkable results of the treatment of refractory multiple myeloma with thalidomide have been reported. In most preceding studies, the given thalidomide dose was escalated to a maximum tolerated dose of up to 800 mg/d. The frequency of adverse effects correlates with dose intensity. Since a significant gain of therapeutic effects could not be observed as thalidomide dosage was escalated, the optimal dose of thalidomide remains to be determined. We report the results of a study with low dose thalidomide (median administered dose 100 mg/d, range 50-400 mg/d). Twenty-four relapsed (n=19) or resistant (n=5) multiple myeloma patients were included in the study. Twelve patients (50%) received thalidomide as monotherapy, 8 patients (33%) received a combination of thalidomide and dexamethasone (every 4 weeks 40 mg/day for 4 days) and 4 patients (17%) who were resistant to vincristine, doxorubicin, dexamethasone (VAD) received VAD combined with thalidomide. Overall, a response was observed in 12 patients (50%). Of the 12 patients treated with low dose thalidomide alone 5 (42%) responded, of the 8 patients who received a combination of thalidomide and dexamethasone 5 (63%) responded and of the 4 patients who had thalidomide in addition to VAD 2 patients (50%) responded. In 3 patients, thalidomide treatment had to be discontinued because of side effects and 1 patient died before response could be assessed. We conclude that low dose thalidomide is an effective and safe rescue therapy in relapsing or refractory multiple myeloma. Response to thalidomide might be dependent on prognostic parameters and tumor burden. To answer these questions larger prospective studies are necessary.     

T - VAD 方案联合自体外周血造血干细胞移植治疗多发性骨髓瘤的疗效观察

目的：观察 T - VAD 方案联合自体外周血造血干细胞移植（ autologous peripheral blood hematopoietic stem cells，APBSC）治疗多发性骨髓瘤（multiple myeloma，MM）的临床疗效及不良反应。方法：选取2010年1月-2014年12月采用 T - VAD 方案联合自体外周血造血干细胞移植治疗的30例多发性骨髓瘤患者的临床资料进行回顾性研究。T - VAD 方案：沙利度胺起始剂量为50mg/晚，每周增加50～100mg/晚，最大剂量200mg/晚，若无明显不适，持续服用。长春新碱0.4mg/ d，静脉滴注，第1～4d；多柔比星10mg/（m2·d），静脉滴注，第1～4d；地塞米松40mg/ d，静脉滴注，第1～4d，第9～12d，28d 为一个疗程，共4个疗程。T - VAD 方案4个疗程诱导治疗后给予自体外周血造血干细胞采集、移植术。结果：患者移植术后，造血功能均顺利重建，无移植相关的死亡发生。30例患者在移植后3个月，完全缓解10例（33.3%），高质量缓解（非常好的部分反应，VGPR）16例（53.3%），部分反应2例（6.6%），无变化2例（6.6%）。不良反应主要有不同程度的恶心、呕吐、脱发及骨髓抑制等。结论：T - VAD 联合自体外周血造血干细胞移植治疗多发性骨髓瘤疗效明显，患者耐受性好。     

改良VAD方案联合沙利度胺治疗多发性骨髓瘤

目的:观察改良VAD方案联合沙利度胺治疗多发性骨髓瘤的临床疗效和不良反应。方法:12例多发性骨髓瘤均采用改良VAD方案联合沙利度胺治疗。沙利度胺的起始剂量为100mg/天,每周增加100mg,直至剂量增加至300mg/天。28天为1周期。治疗2个周期后,根据血象、血清M蛋白、血清肌酐、骨髓瘤细胞等指标来判断疗效,分为部分缓解、改善和无效。结果:部分缓解6例,改善4例,总有效率为83·3%。主要不良反应有嗜睡(75%)、便秘(50%)、头晕(25%)和感染(25%),但都能耐受。结论:改良VAD方案联合沙利度胺治疗多发性骨髓瘤具有疗效高和耐受性好的优点,尤其是对于有合并症的老年患者是安全的,值得进一步的临床观察和推广。     

硼替佐米联合阿霉素、地塞米松治疗初治多发性骨髓瘤的疗效观察

目的　比较硼替佐米联合阿霉素、地塞米松方案（ＰＡＤ方案）与长春新碱联合阿霉素、地塞米松方案（ＶＡＤ方案）治疗初治多发性骨髓瘤（ＭＭ）的疗效和不良反应。方法　ＰＡＤ方案组４１例患者给予硼替佐米１.３ｍｇ／ｍ２静推,第１、４、８、１１天;阿霉素１０ｍｇ／ｄ静滴,第１～４天;地塞米松２０ｍｇ／ｄ静滴,第１～４天,３周为１个周期,每例接受２～６个周期化疗。４０例ＶＡＤ方案组患者予长春新碱０.５ｍｇ／ｄ静滴,第１～４天;阿霉素１０ｍｇ／ｄ静滴,第１～４天;地塞米松２０ｍｇ／ｄ静滴,第１～４天,４周为１个周期,每例接受２～８个周期化疗。化疗２个周期后评价两组患者的疗效和不良反应。结果　两组患者均可评价疗效和不良反应。化疗２个周期后,ＰＡＤ方案组获显效２２例（５３.７％）,ＶＡＤ方案组获显效１０例（２５.０％）,差异有统计学意义（Ｐ＜０.００１）。两组主要不良反应包括消化道症状、周围神经炎、血小板减少、白细胞减少和感染,多为１～２级,经对症治疗后均可缓解。结论 ＰＡＤ方案治疗初治ＭＭ的显效率明显高于ＶＡＤ方案,不良反应可耐受。     

硼替佐米联合改良VAD方案治疗多发性骨髓瘤疗效观察

目的:观察硼替佐米联合改良VAD方案（PVAD）治疗多发性骨髓瘤（multiple myeloma）的疗效和安全性。方法:共有52例MM患者接受了2~8个疗程PVAD方案化疗。PVAD方案:硼替佐米（万珂）1.3mg/m2,3秒内快速注射,d1,4,8,11;长春瑞滨10mg/d 静滴,d1~4;吡柔比星10mg/d 静滴,d1~4;地塞米松20mg/d 静滴,d1~4。每28天为1个疗程,观察疗效和不良反应。结果:总体反应率［完全缓解（CR）+接近完全缓解（nCR）+部分缓解（PR）+轻微反应（MR）］为92.3%（48/52）,治疗有效率（CR+PR）为88.5%（46/52）。其中在PVAD方案治疗前接受过VAD方案治疗的21例患者中,18例有效,治疗有效率（CR+PR）为85.7%（18/21）。最常见的血液系统不良反应包括白细胞减少、贫血、血小板减少。非血液系统不良反应主要为乏力、外周神经病变、腹胀/便秘等消化道症状、带状疱疹、呼吸道感染、血栓形成等,经对症处理后均可缓解或恢复。结论:PVAD方案在初发或难治复发的多发性骨髓瘤中均有较好疗效,且具有良好的安全性和耐受性。优于单用硼替佐米或单用VAD方案。     

Effect of different doses of dexamethasone combined with bortezomib and thalidomide in treatment of elderly patients with multiple myeloma

Objective: To observe the efficacy and safety of different doses of dexamethasone combined with bortezomib and thalidomide in the treatment of elderly patients with multiple myeloma (MM). Methods: A total of 33 elderly MM patients treated in Shanghai Fifth People's Hospital between August 2014 and August 2019 were enrolled in the study. According to the dosage of dexamethasone, the patients were divided into the observation group (low dose dexamethasone, 20 mg/d on day 1-4, and 11-14) and the control group (high dose dexamethasone, 40 mg/d on day 1-4, 9-12, and 17-20). Twenty-eight days was a course of treatment. The clinical efficacy and safety of patients was assessed after 4 courses of treatment. The patients were followed up till June 30th, 2021. Kaplan-Meier and log-rank were used to analyze the survival. Results: The overall response rate (ORR) and median overall survival (OS) were not significantly different between the observation and control groups (82.4% vs 87.5%, P=0.973; 58 months vs 61 months, P=0.859). The incidence rates of lung infection and hyperglycemia in the observation group were both significantly lower than those in the control group (both P< 0.05). Conclusions: Different doses of dexamethasone combined with bortezomib and thalidomide have definite curative effects in the treatment of elderly MM patients. But low dose dexamethasone has fewer adverse reactions and better safety. © 2022, The Second Affiliated Hospital, College of Medicine, Zhejiang University.. All right reserved.     

核素骨显像在多发性骨髓瘤疗效评价中的应用

Objective:To investigate the value of radionuclide whole-body bone imaging on monitoring chemotherapeutic effects for multiple myeloma(MM).Methods:Sixty patients were included.Twenty nine cases received CTD(thalidomide 100-200 mg/d;cyclophosphamide 200-300 mg/m2/d,1-4 days,every 4 weeks;and dexamethasone 20-40 mg/d,1-4 days,every 4 weeks);Thirty cases received VAD(vincristine 0.4 mg/d,1-4 days,every 4 weeks;adriamycin 10 mg/d,1-4 days,every 4 weeks;dexamethasone 40 mg/d,1-4 days,every 4 weeks).Radionuclide bone imagings were performed in all patients before chemotherapy,six months,twelve months and eighteen months after chemotherapy.The correlation of chemothera-peutic effects between CTD and VAD were analyzed.Results:One hundred and seventy nine bone lesions were visualized by bone scintigraphy before CTD treatment.Eighteen months after CTD chemotherapy,it was observed by bone scintigraphy that 39/179(21.78%) lesions disappeared,112/179(62.57%) improved,and 28/179(15.64%) had no change.One hundred and ninety one bone lesions were showed by bone imaging before VAD treatment,36/191(18.84%) lesions disappeared,eighteen months after chemotherapy,103/191(53.92%) improved,and 52/191(27.22%) had no change.The significant difference was observed in locations of MM induced bone lesions treated with CTD(H = 8.23,P < 0.05) and VAD(H = 11.18,P < 0.05).A significant chemotherapeutic sensitivity in detecting MM induced lesions in ribs was found compared with other bone lesions.The chemotherapeutic effect of CTD was statistically significant than that of VAD(U = 2.17,P < 0.05).Conclusion:Radionuclide whole-body bone imaging has great value in monitoring chemotherapeutic effects for MM.     

Treatment of Waldenstrom's macroglobulinemia with single-agent thalidomide or with the combination of clarithromycin,thalidomide and dexamethasone

To evaluate the activity of thalidomide in Waldenstrom's macroglobulinemia (WM), 20 patients were treated on a dose schedule that escalated from 200 mg/d to 600 mg/d. On an intention-to-treat basis, five (25%) patients achieved a partial response, which was noted within 3 months of treatment. Adverse effects were common and prevented dose escalation of thalidomide in 75% of patients and led to premature discontinuation of treatment in 35%. We subsequently evaluated the oral combination of clarithromycin (500 mg twice per day), low-dose thalidomide (200 mg once daily), and dexamethasone (40 mg once per week). Our preliminary analysis on 12 previously treated patients indicate activity of this regimen in WM: three patients achieved a partial response and two patients demonstrated monoclonal protein reduction of greater than 25%. This combination was associated with a variety of side effects due not only to thalidomide, but also to corticosteroids and to clarithromycin. Our preliminary data indicate that this combination may be a useful salvage regimen for some patients with heavily pretreated macroglobulinemia.