多发性骨髓瘤临床特征及疗效分析

目的总结多发性骨髓瘤（multiple myeloma,MM）的发病特征及临床特征,分析比较不同治疗方案对MM的疗效及不同类型与不同临床特征的MM治疗效果。方法回顾性分析2003年1月2008年1月128例MM患者的发病和临床特征,以及与治疗效果的关系,并对不同治疗方案、不同类型间的疗效进行比较。结果 MM患者发病的中位年龄为59岁,临床上以不明原因的骨痛、贫血、感染和球蛋白增高为主要表现。128例患者中行方案一（马法兰、强的松/地塞米松、反应停）的总有效率为53.3%（32/60）;方案二（环磷酰胺、长春新碱、马法兰、强的松、卡氮芥、阿霉素）为44.4%（8/18）;方案三（长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松）为68.5%（24/35）,方案四（硼替佐米、地塞米松/反应停）的总有效率为86.6%（13/15）。方案一和方案二间、方案三和方案四间疗效差异无统计学意义（P〉0.05）,方案三、方案四的疗效均优于方案一和方案二（P〈0.05）。IgG型总有效率为63.2%（48/76）,IgA型为60.9%（14/23）,kappa轻链型为42.8%（6/14）,lammda轻链型为46.2%（6/13）。IgG型和IgA型间的疗效差异无统计学意义（P〉0.05）,但IgG型、IgA型的疗效均优于kappa轻链型和lammda型（P〈0.05）。不同类型及使用不同方案的患者,其中位生存期及3年和5年的生存率差异无统计学意义（P〉0.05）。结论 MM患者发病高峰年龄介于40～70岁,骨痛和贫血是最常见的首发症状。长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松以及硼替佐米、地塞米松/反应停方案总体疗效相当,但后者完全缓解率高于前者。

Research of Clinical Features and Therapeutic Effects in Patients with Multiple Myeloma

Objective To investigate and compare the effects of different chemotherapy regimens on these patients with multiple myeloma （MM）. Methods The clinical data of 128 patients with MM were retrospectively analyzed from January 2003 to January 2008. Relationship between their clinical features and the efficacy was analyzed. The effectiveness was compared among different regiments and among different types of diseases. Results The median age was 59 years old for theses patients whose main manifestation were osteodynia,anemia,infection and an adscendent level of globulin. Among 128 patients,the total effective rate of program 1 （melphalan,prednisone/dexamethasone,and/or thalidomide） was 53.3% （32/60）,the program 2 （cyclophosphamide,vincristine,melphalan,prednisone,BCNU,and doxorubicin） was 44.4% （8/18）,the program 3 （vincristine,adriamycin/pharmorubicin posomal doxorubicin and dexamethasone） was 68.5% （24/35）,and the program 4 （bortezomib,dexamethasone/thalidomide） was 86.6% （13/15）. There was no statistical difference in the chemotherapy effects between program 1 and program 2,as well as program 3 and program 4 （P〉0.05）. The effectiveness of programs 3 and 4 were better than those of the programs 1 and 2 （P〈0.05）. The total effective rates of type IgG,IgA,kappa light chain and lammda light chain were 63.2% （48/76）,60.9% （14/23）,42.8% （6/14） and 46.2% （6/13）,respectively. There was no significant difference in therapeutic effects between types IgG and IgA （P〉0.05）,while the types IgG and IgA were superior to kappa and lammda light chain types （P〈0.05）. There was no significant difference in median survival time and total survival rates of 3 or 5 years among the different types and therapeutic regimens （P〉0.05）. Conclusion The range of peak age of patients who suffered from MM is from 40 to 70 years old,while the osteodynia and anemia are the most initial symptoms. There is a therapeutic equivalence between program 3 （vincristine,adriamycin/pharmorubicinposomal doxorubicin and dexamethasone） and program 4 （bortezomib,dexamethasone/thalidomide）,however the latter has a higher complete remission rate.