硼替佐米联合地塞米松、沙利度胺治疗初治多发性骨髓瘤疗效观察

目的观察硼替佐米联合地塞米松、沙利度胺治疗初治多发性骨髓瘤（MM）患者的疗效和安全性。方法12例初治MM患者采用硼替佐米联合地塞米松、沙利度胺方案化疗,观察其疗效及不良反应。结果12例初治MM患者总有效率为83．3％,其中非常好的部分缓解4例（33．3％）,部分缓解6例（50％）。最常见的不良反应为胃肠道症状、乏力、感染、血小板减少、周围神经病变等,通过对症治疗或停药后均可恢复。结论硼替佐米联合地塞米松、沙利度胺对初治MM患者是一种疗效确切、可以耐受的治疗选择。     

常规化疗联合硼替佐米、沙利度胺治疗对新发骨髓瘤患者肾功能的影响

目的:分析常规化疗联合硼替佐米、沙利度胺治疗新发骨髓瘤患者的效果,探讨其对肾功能的影响.方法:随机将88例患者分成对照组、观察组,对照组利用常规方法治疗,观察组联合使用常规化疗、硼替佐米及沙利度胺进行治疗,对比两组患者的病情缓解与肾功能改善情况.结果:观察组患者肾功能逆转与肾功能好转均高于对照组,差异对比不存在统计学意义,P>0.05;观察组总有效率、总体有效率明显高于对照组,差异明显,具有统计学意义,P<0.05.结论:联合利用常规化疗、沙利度胺及硼替佐米对新发骨髓瘤患者进行治疗,可以获得较为明显的临床效果,有效逆转患者肾功能,值得在临床治疗中进行进一步推广     

针对多发性骨髓瘤的三种化疗方案治疗效果的分析

目的 剖析三种化疗方案VD、PAD、VRD治疗多发性骨髓瘤(multiple myeloma, MM)的效果,为临床选择合理的化疗方案提供建议。方法 选择2019年3月—2022年3月甘肃宝石花医院收治的MM患者95例,根据选用化疗方法的不同,分为VD组27例、PAD组35例和VRD组33例,VD组采用硼替佐米+地塞米松的化疗方案,PAD组采用硼替佐米+阿霉素+地塞米松的化疗方案,VRD组采用硼替佐米+来那度胺+地塞米松的化疗方案;对比三组MM化疗方案应用效果,分析三种方案的优缺点。结果 VD、PAD和VRD方案,均可有效缓解和治疗MM;3药联合方案PAD、VRD优于2药方案VD;PAD和VRD方案,疗效相当。结论 在兼顾患者体况、疗效和经济因素的原则下,对于基础评估心脏功能不全、器官功能低下的患者,可选用VD方案化疗;一般器官功能良好、可行诱导后移植的患者,可选用PAD方案化疗;心脏功能不全、不能耐受联合化疗、拟行诱导后移植的患者,可选用VRD方案化疗,该方案化疗不良反应更小。     

常规化疗联合硼替佐米及沙利度胺对新发骨髓瘤患者的影响

目的探究常规化疗联合硼替佐米及沙利度胺对新发骨髓瘤患者伴肾功能衰竭的影响。方法将2013年6月—2015年8月收治的89例新发骨髓瘤伴肾功能衰竭患者随机分为对照组和观察组,对照组实施常规化疗治疗,观察组在常规化疗的前提下加用硼替佐米与沙利度胺治疗,比较两组肾功能改善效果与病情改善情况进行对比,计数资料采用χ~2检验,以P0.05为差异有统计学意义。结果观察组肾功能改善总有效率78.95%高于对照组的53.12%,两组比较差异有统计学意义(χ~2=6.466,P0.05);观察组总有效率80.70%高于对照组的53.12%,两组比较差异有统计学意义(χ~2=7.537,P0.05)。结论新发骨髓瘤患者伴肾功能衰竭采用常规化疗与加用硼替佐米与沙利度胺的治疗效果显著,可使患者的肾功能明显改善,在临床上有较高的应用价值。     

硼替佐米和沙利度胺治疗对多发性骨髓瘤患者外周血T细胞亚群及相关细胞因子的影响

目的探讨分析硼替佐米和沙利度胺治疗对多发性骨髓瘤(MM)患者外周血T细胞亚群及相关细胞因子的影响。方法选择2016年3月-2018年3月本院收治的初发MM患者78例,随机分为硼替佐米组40例、沙利度胺组38例,再选择50例健康志愿者作为对照组。硼替佐米组患者给予硼替佐米联合地塞米松治疗,沙利度胺组患者给予沙利度胺、长春新碱、表柔比星联合地塞米松治疗。比较2组治疗疗效,检测2组MM患者治疗前后及对照组外周血Th17、Treg细胞比例以及IL-6、IL-17、TGF-β水平。结果 2组MM患者治疗后Treg显著升高(P 0.05),Th17细胞比例显著降低(P 0.05),且硼替佐米组改善程度更优(P 0.05)。2组MM患者治疗后血清IL-6、IL-17以及TGF-β水平较治疗前显著降低(P 0.05),且治疗后硼替佐米组血清IL-6、IL-17以及TGF-β水平显著低于沙利度胺组(P 0.05)。结论硼替佐米和沙利度胺治疗多发性骨髓瘤均具有一定的疗效,可有效改善机体Treg、Th17细胞比例,降低血清IL-6、IL-17以及TGF-β细胞因子表达,且以硼替佐米联合地塞米松治疗方案效果更佳。     

硼替佐米与雷利度胺联合地塞米松治疗多发性骨髓瘤的疗效及感染分析

目的对比硼替佐米与雷利度胺联合地塞米松治疗对多发性骨髓瘤(MM)的疗效,为MM的临床治疗方案选择提供理论依据。方法选取医院2008年6月-2010年6月收治的190例MM患者,按照随机数字表分为A、B两组,各95例,分别实施硼替佐米联合地塞米松方案与雷利度胺联合地塞米松方案进行治疗,比较两组患者治疗前后血红蛋白、血清肌酐、血清M蛋白及骨髓浆细胞等指标,分析疗效。结果两组治疗后血红蛋白显著上升,血清肌酐、血清M蛋白及骨髓浆细胞均显著下降,且B组改变程度较A组更为显著;A组完全缓解10例,非常好的部分缓解24例,部分缓解25例,总有效率61.1%,B组分别为16、31、28例,总有效率78.9%,B组治疗效果显著优于A组;A组及B组患者不良反应发生率分别为23.2%及7.4%,A组患者出现4例肺部感染,B组出现2例医院感染。结论硼替佐米联合地塞米松方案与雷利度胺联合地塞米松方案均可有效改善MM患者临床症状,使其预后和生活质量得到提高,而雷利度胺联合地塞米松方案具有更好的疗效及减少肺部感染机会,是治疗以中老年患者为主的MM的黄金方案,值得临床广泛推广。     

硼替佐米对多发性骨髓瘤患者联合化疗安全性及预后的影响

目的分析硼替佐米对多发性骨髓瘤(MM)患者联合化疗安全性及预后的影响,探讨其临床价值。方法选取宿州市立医院2014年1月～2016年1月收治的86例MM患者,使用随机数表法,纳入观察组和对照组,每组43例。对照组接受长春新碱+阿霉素+地塞米松(VAD±T)联合化疗方案治疗,联合或不联合沙利度胺;观察组在对照组治疗方案的基础上,加用硼替佐米治疗。评价两组患者治疗效果、不良反应及3年总生存期(OS)、无进展生存期(PFS),分析硼替佐米在MM联合化疗中的应用价值。结果疗程结束后,观察组总有效率为53.48%,高于对照组的30.23%,差异有统计学意义(P 0.05)。两组患者化疗期间不良反应发生情况比较,差异无统计学意义(P 0.05)。观察组随访期间失访2例,对照组失访3例,其余患者均获得有效随访,随访时间均≥3年。观察组中位PFS、OS分别为17个月、26个月,高于对照组的12个月、19个月。结论在常规联合化疗方案的基础上加用硼替佐米,能够在保证治疗安全性的前提下改善患者预后质量,延长生存时间,值得广泛应用。     

替吉奥联合沙利度胺治疗32例晚期胃癌的临床分析

目的分析替吉奥联合沙利度胺治疗晚期胃癌患者的有效性和安全性。方法对32例晚期胃癌患者采用口服替吉奥联合沙利度胺治疗,其中沙利度胺爬坡至治疗量后长期每日200mg口服,替吉奥服药28d停14d,42d为1个周期。治疗后进行疗效评定及不良反应评估。结果32例患者中CR0例,PR10例,SD14例,PD8例。有效率31．2％,疾病控制率75％。主要的不良反应为消化道症状（53．1％）、骨髓抑制（46．9％）、皮肤色素沉着（31．2％）、便秘（37．5％）和疲乏（28．1％）,均为I～Ⅱ度。结论替吉奥联合沙利度胺治疗晚期胃癌患者近期疗效较好,不良反应轻,可改善依从性,适用于不能耐受常规联合化疗与不愿接受静脉化疗的患者。     

硼替佐米治疗恶性血液病研究进展

近年来,蛋白酶体抑制剂硼替佐米作为一种新的有效抗肿瘤药物,用于恶性血液病治疗取得了较大进展。本文对硼替佐米作用机制、药理、临床疗效及其毒副作用作一综述。     

以硼替佐米为基础的化疗方案对多发性骨髓瘤的疗效及预后

目的观察以硼替佐米为基础的化疗方案治疗多发性骨髓瘤(MM)的疗效及预后效果。方法随机选取本院于2016年10月至2017年10月收治的46例多发性骨髓瘤患者,将其中23例初治疗者纳入A组,其余23例复发、难治者纳入B组。A照组患者采取硼替佐米联合地塞米松化疗方案(PD),B组患者则采取硼替佐米联合吡柔比星及地塞米松化疗方案(PAD)。两组均进行1～6疗程治疗,之后口服沙利度胺维持治疗,观察两组疗效、不良反应及预后情况。结果两组患者均随访4～35个月,平均随访时间为17个月。随访中发现A组总体缓解率为86.96%,高于B组的60.87%,差异有统计学意义(P0.05)。两组MM患者在采取以硼替佐米为基础的化疗方案治疗中,主要毒副反应包括17例胃肠道反应,22例血小板减少,15例白细胞减少,11例周围神经病变,15例感染。A组发生胃肠道反应7例(30.43%),白细胞减少7例(30.43%),周围神经病变5例(21.74%),感染6例(26.09%)。B组发生胃肠道反应10例(43.48%),白细胞减少8例(34.78%),周围神经病变6例(26.09%),感染9例(39.13%)。两组患者不良反应发生例次率比较差异无统计学意义(P0.05),两组均未发生严重反应,患者经对应处理或停药后多数有改善,部分为不可逆改变。结论对初治多发性骨髓瘤患者应用硼替佐米与地塞米松联合化疗方案具有迅速减小肿瘤、整体反应率低、完全缓解率高的优点,但对于复发难治性患者虽然治疗反应率较好,但疗效低于初治者。该治疗方案不良反应例次率较高,但均能够预测和控制,患者整体耐受性较好。     

中医扶正培本对初治急性白血病化疗患者扶正减毒作用的临床研究

目的探讨中医扶正培本对白血病化疗患者扶正减毒作用的临床效果。方法选取我院收治的52例初治急性白血病化疗患者按随机化原则分为2组。对照组26例单纯给予化疗药物治疗,观察组26在对照组的基础上给予参芪扶正注射液中医扶正培本治疗,对比两组患者治疗期间周围血象、生活质量及化疗毒性反应等进行比较分析。结果观察组患者治疗后1疗程临床完全缓解率84.6%,明显高于对照组的61.5%,两组比较差异有统计学意义（P〈0.05）;观察组患者临床治疗后未缓解的15.4%,明显的小于对照组的38.5%,两组比较差异有统计学意义（P〈0.05）;观察组患者治疗期间出现胃肠道反应的10.0%、骨髓抑制的15.0%、肝功损害的10.0%、肾功损害的5.0%,明显小于对照组的胃肠道反应25.0%、骨髓抑制的30.0%、肝功损害的20.0%、肾功损害的20.0%,两组比较差异有统计学意义（P〈0.05）。结论中医扶正培本治疗对白血病化疗患者具有良好的扶正减毒效果,明显改善了患者化疗期间的成活质量,有效降低了化疗期间化疗药物毒副作用的发生情况,提高了临床治疗效果及有效率,值得我们临床上进一步推广应用。     

Hematopoietic stem cell transplantation in multiple myeloma

Multiple myeloma (MM) is the second most common hematologic malignancy, affecting approximately 14,000 new patients per year in the United States. For over four decades, the standard treatment for MM has been a regimen of melphalan combined with prednisone. Using this treatment modality, complete responses are rare, and 50% of patients have had disease that was resistant to chemotherapy. Attempts have been made to improve the outcome of MM by administering combinations of i.v. poli-chemotherapy, but these treatments are equivalent in terms of overall survival. High-dose therapy with peripheral blood stem cell support can be applied safely in these patients and achieves significantly higher complete remission rates as well as better event-free survival and overall survival. However, neither tumor-cell purging, positive selection, intensification of conditioning with additional chemotherapeutic agents, nor total body irradiation have been shown to improve outcome. The role of tandem transplantation with high-dose melphalan seems to be a good selection of treatment in hospitals having all resources. Future research will include the combination of the best remission-induction regimen with tandem transplants and maintenance treatments (thalidomide, idiotype or dendritic cell vaccination) that will sustain complete remission. Development of non-myeloablative allogeneic transplantation in order to exploit the graft-versus myeloma effect provides an alternative for patients who have a compatible donor. Combining all of these modalities with the new drugs developed few years ago (thalidomide, bortezomib, revlimid), we hope that MM will become a manageable chronic disease and perhaps a curable disease at least for 30% to 40% of the patients.     

Long-term survival and prognostic factors in multiple myeloma treated with conventional chemotherapy. Report of 109 cases

Our study is retrospective. We report the results of conventional chemotherapy ins previosly untreated patients with myeloma. Survival and prognostic factors were analysed in 109 patients diagnosed from 1983 to 1992. The median age was 65 years, 87 patients (80%) were including in the stage III according the Durie Salmon staging system. The median survival time was 27 months and 10 years survival rate is 3.66%. In the univariate analysis, two prognostic variables were retained namely the hemoglobin and creatinine level. The study suggest that conventional therapy is a good treatment for old patients. However, patients younger than 55 years, must benefit from intensive chemotherapy supported by autologous bone marrow, pheripheral blood stem cells, or allogenic bone marrow transplantation. A considerable encrace in duration of remission and survival is possible.     

三氧化二砷、维甲酸联合化疗序贯治疗对急性早幼粒细胞白血病的长期疗效

目的总结三氧化二砷（As2O3）、全反式维甲酸（ATRA）及化疗的序贯巩固方案对急性早幼粒细胞白血病（APL）的远期疗效。方法对我院1996～2006年间诊断为APL的40例患者,缓解后用序贯方案进行巩固治疗的24例,回顾性地与单用维甲酸进行巩固治疗的16例作比较,随访时间至少超过5年,评价两组间的复发率及5年无病生存率的差异。结果接受序贯巩固治疗患者的复发率仅4%,单用维甲酸组复发率为26.6%,5年生存率两组分别为96%及81%。结论接受序贯巩固方案有利于减低APL的复发率,提高患者的5年无病生存率。     

Effective PAD (bortezomib, doxorubicin, dexamethasone) treatment of a patient with plasma cell leukaemia that has developed after autologous stem cell transplantation

The most aggressive and rare manifestation of multiple myeloma is plasma cell leukaemia (PCL). While secondary form of PCL represents those heavily pretreated cases when leukaemic transformation develops terminally after intensive chemotherapy in patients with multiple myeloma, primary cases are characterized by leukaemic symptoms present at diagnosis. The secondary form has a rapid progression. The management of PCL is still unsolved. The authors present a case of a patient with non-secretory multiple myeloma who had developed plasma cell leukaemia after peripheral stem cell transplantation. PAD (bortezomib, doxorubicin, dexamethasone) treatment resulted in complete remission and 9-month survival of the patient. Previous case reports in the literature and our experience have revealed PAD protocol to be well tolerated and effective in PCL. Combination of PAD treatment with autologous and/or allogenic stem cell transplantation might further improve patients' outcome.     

诱导化疗期高血糖对急性淋巴细胞白血病预后的影响

目的探讨急性淋巴细胞白血病诱导化疗期高血糖对并发症、缓解期和生存期的影响。方法回顾性分析98例成人急性淋巴细胞白血病高血糖和无高血糖患者并发症发生的情况；Kaplan-Meier方法评价两组生存期和缓解期；Cox风险比例模型分析白血病复发和死亡的风险因素。结果伴高血糖的急性白血病患者年龄较大，易出现血小板减少，治疗后易并发感染，易发生败血症，周围神经病变的发生率也明显升高。高血糖患者生存期和缓解期明显缩短。结论急性淋巴细胞白血病诱导化疗期的高血糖增加治疗后并发感染的发生率，增加白血病复发和死亡的风险。     

New experimental and clinical data on leukaemia immunotherapy.

The present results of our treatment of acute lymphoid leukaemia patients are summarized: 7 out of 20 randomized patients given active immunotherapy after chemoradiotherapy are still in complete remission after periods varying from seven to ten years (compared to none in the control group). The actuarial results on 100 patients show remission and survival curves presenting a plateau between three and five years for a certain percentage, suggesting a possible cure. Several parameters studied in 200 patients indicate that the factors affecting this percentage are age, cytological type, volume of the tumour, and the localization of leukaemic cells in certain areas. Experiments with L1210 leukaemia show that immunotherapy enhances the effect of chemotherapy when administered after chemotherapy but decreases it when administered before, which is in favour of the use of the sequence chemotherapy-immunotherapy clinically.     

Treatment of primary mediastinal large B-cell lymphomas

INTRODUCTION: Primary mediastinal large B-cell non-Hodgkin's lymphoma is a relatively rare disease with specific clinical symptoms. This tumour originates from a subset of B-cells of the thymus and at the time of the diagnosis the disease is predominantly localised in the mediastinum. The tumor grows rapidly and frequently involves other thoracic structures. The majority of the patients are young females. There are no histologic features that reliably distinguish these tumors from other diffuse large B-cell lymphomas. This is the only lymphoma subtype which can only be defined by the combination of clinical and pathologic features. Analysis with DNA microarrays verified that primary mediastinal and diffuse large B-cell lymphomas are different diseases. AIMS: Comparing the effectiveness of two types of anthracycline-based standard chemotherapy regimens and the evaluation of the prognostic markers which are applied in large B-cell lymphomas. METHODS: 27 patients with primary mediastinal lymphoma were treated by the authors with anthracycline-based polychemotherapy with complementary radiotherapy from January 1995 to December 2002. RESULTS: Complete remission was obtained in 15 patients (56%) and no relapse was observed in this group. 9 additional patients (33%) achieved partial remission, while in 3 cases (11%) the treatment was ineffective. The patients who failed to achieve complete remission were subsequently treated with more intensive chemotherapy. Afterwards, those patients who were chemosensitive, underwent high-dose chemotherapy with autologous peripheral blood stem-cell transplantation. The chemoresistant patients received palliative chemotherapy. The 5-year overall survival rate of the 27 patients was 62.11%. CONCLUSION: The authors found that the procarbazine, prednisolone, adriamycin, cyclophosphamide, etoposide, cytosine-arabinoside, bleomycin, vincristine, methotrexate treatment was more effective than the cyclophosphamide, adriamycin, vincristine, prednisolone combination. The expected 5-year overall survival rates were 83.57% vs. 33.33%, respectively. This difference was significant (p = 0.017). No prognostic value of age adjusted international prognostic index, LDH- and b2-microglobulin levels were found. The results with the new standard of combined immuno-chemotherapy (rituximab--cyclophosphamide, adriamycin, vincristine, prednisolone) seem to be hopeful and more effective than earlier treatments.     

Patient's selection for lung transplantation, and management during the waiting time

Lung transplantation is now generally accepted as a useful modality of care for patients with severe life-threatening respiratory diseases that are refractory to conventional therapies. Lung transplantation is indicated for patients with end stage lung diseases, who demonstrate declining function despite maximal therapy. The author reports own experience of selection, timing referrals for lung transplantation, and the management of patients on the waiting list. Eleven patients were selected for lung transplantation. Eight of them suffered from end stage pulmonary fibrosis, two of them cystic fibrosis, and one patient had pulmonary hypertension. Seven patients underwent a successful lung transplantation and four patients died during the investigations, before the operation, due to respiratory failure, and pulmonary heart disease. It is generally recommended to consider transplantation when patients who suffer in the end stage pulmonary disease are symptomatic during daily activities too, due to pulmonary status and the expected survival is to be strongly limited, less than two years.     

FOLFIRI化疗方案及其与西妥昔单抗联用治疗晚期结肠癌分析

目的比较西妥昔单抗（爱必妥）联合FOLFIRI化疗方案治疗晚期结肠癌与单纯FOLFIRI化疗方案治疗晚期结肠癌的疗效。方法将我院2008年1月至2009年12月58例采用西妥昔单抗联合FOLFIRI化疗治疗的结肠癌患者作为观察组,将我院2006年1月至2007年12月只使用了FOLFIRI化疗方法治疗的49例结肠癌患者作为对照组。比较两组患者的治疗后生存状况。结果观察组的病情缓解率和治疗后生存质量都好于对照组,毒副作用两组患者反应都不明显。结论FOLFIRI方案联合西妥昔单抗治疗晚期结肠癌,比单独的FOLFIRI化疗方案取得了更好的治疗效果,可明显缓解患者病情,提高患者生存率和生活质量,毒副反应也较轻,处于患者可耐受范围之内。