低剂量硼替佐米为主的三联化疗在老年多发性骨髓瘤的疗效分析

目的:探讨低剂量硼替佐米为基础的三联化疗在老年多发性骨髓瘤的疗效及安全性。方法:选取58例老年(年龄≥60岁)多发性骨髓瘤患者,根据用药方案分为3组。A组:硼替佐米0.7 mg/m^2,d 1、4、8和11;环磷酰胺0.5 g/m^2,d 1和8;地塞米松20 mg/d,d 1-2、4-5、8-11和11-12。B组:硼替佐米1.3 mg/m^2,d 1、4、8和11;环磷酰胺0.5 g/m^2,d 1和8;地塞米松20 mg/d,d 1-2、4-5、8-11和11-12。C组:硼替佐米0.7 mg/m^2,d 1、4、8和11;地塞米松20 mg/d,d 1-2、4-5、8-11和11-12。3组患者均治疗4个疗程,比较3组的疗效及治疗反应。结果:3组患者的完全缓解(CR)率分别为31.58%、38.09%和27.78%,总有效(ORR)率分别为68.42%、66.67%和55.56%(P>0.05)。有贫血的多发性骨髓瘤患者经治疗后血红蛋白水平均较基础值明显上升;3组患者4个疗程期间的人均红细胞血输注、化疗后的骨髓抑制率、感染率均无统计学差异。3组周围神经病、胃肠道反应、带状疱疹发生率有统计学差异,A组较其他2组明显降低。随访1年,3组患者生存率无统计学差异。结论:以低剂量硼替佐米为主的3药联合治疗老年多发性骨髓瘤患者的疗效反应与标准剂量类似,但周围神经病、胃肠道反应、带状疱疹的发生率均较低,患者对减低剂量联合方案具有更好的耐受性。

Clinical Efficacy of Low-Dose Bortezomib-Based Triple Combination Therapy in the Treatment of Elderly Multiple Myeloma

Objective:To investigate the clinical efficacy and safety of low-dose bortezomib-based triple combination therapy in the treatment of elderly multiple myeloma(MM).Methods:Fifty-eight patients with elderly multiple myeloma were selected.And according to the drug rigimen the patients were randomly divided into three groups.Group A:patients received low-dose bortezomib(0.7 mg/m^2)on day 1,4,8 and 11;cyclophosphamide(0.5 g/m^2)d 1,d 8;dexamethasone d1-2,d 4-5,d 8-11,d 11-12.Group B:patients received bortezomib(1.3 mg/m^2)on day 1,4,8 and 11;cyclophosphamide(0.5 g/m^2)d 1,d 8;dexamethasone d 1-2,d 4-5,d 8-11,d 11-12.Group C:patients received bortezomib(0.7 mg/m^2)on day 1,4,8 and 11;dexamethasone d 1-2,d 4-5,d 8-11,d 11-12.All patients in three groups were treated for 4 circles.The efficacy and response of the three groups were compared.Results:The complete remission(CR)rate in the three groups was 31.58%,38.09%and 27.78%.And the overall response(ORR)rate of the three groups was 68.42%,66.67%and 55.56%,there was no statistical difference among the three groups(P>0.05).The Hb level in MM patients with anemia after treatment was higher than the basic value.There were no statistical differences in percapita red blood cell transfusion,the incidence of bone marrow suppression and infection during 4 courses treatment among 3 groups,but the incidence of peripheral neuropathy,gastrointestinal reaction and herper zoster in group A was significantly lower than that in group B and C,moreover there was statistical difference.After the follow-up for 1 year,there was no significant difference in the survival rate among 3 groups.Conclusion:The efficacy of low dose bortezomib-based triple combination therapy for the patients with elderly multiple mycloma is same efficacy as of standard dose bortezomibbased triple combination therapy,but the incidence of perpheral neuropathy,gastrointestinal reaction and herper zoster is lower,the patients have better torelonce to low dose bortezomib-based triple combination therapy regimen,suggesting that this therapy possesses the efficacy of less adverse reactions and more high safety in treatment of patients with elderly muitipe myelome.