沙利度胺联合VAD方案治疗多发性骨髓瘤的临床研究

目的 :探讨沙利度胺联合VAD方案治疗多发性骨髓瘤 (MM)的临床疗效及不良反应。方法 :5 3例MM患者 ,随机分为VAD方案对照组 :长春新碱加阿霉素加地塞米松 ;治疗组 :VAD方案加沙利度胺 ,沙利度胺起始剂量 2 0 0mg/d ,每 2周增加 5 0～ 2 0 0mg/d ,至患者不能耐受或最高剂量不超过每日 4 0 0mg ,维持该剂量半年。结果 :治疗组部分缓解 10例 (4 3.5 % ) ,进步 9例 (39.1% ) ,无效 4例 (17.4 % ) ,总有效率 82 .6 % (19/2 3) ,明显优于对照组 (总有效率的 5 3.3% ) (P <0 .0 5 ) ;能有效降低M蛋白 ,使骨髓瘤细胞下降 ,提升血红蛋白和改善生活自理状况 (P <0 .0 1) ;治疗后MM患者血清血管内皮细胞生长因子 (VEGF)水平明显下降 ,与对照组比较差异有统计学意义 (P <0 .0 1)。副反应程度均可耐受。结论 :沙利度胺联合VAD方案治疗MM具有副作用少、耐受性好、给药方便、疗效明显的优点 ,值得临床深入研究和推广应用。

The clinical research of thalidomide incorporation with VAD in treatment of multiple myeloma

Objective:To study the curative effect and side effect of thalidomide incorporation with VAD in treatment of multiple myeloma.Method:53 multiple myeloma patients were randomly divided into VAD group, VAD plus thalidomide respectively, the beginning dose of thalidomide was 200 mg/d, increased 50 to 200mg every 2 weeks till the intolerant dose or below 400 mg/d, maintained for half a year.Results:The experimental group had 10 partial relief cases ( 43.5%), 9 improved cases ( 39.1%), 4 inefficacy cases ( 17.4%), total efficacy rate was 82.6% (19/23), significantly higher than that in control group (with total efficacy rate 53.3%) (P< 0.05); the experimental schema effectively brought down the M protein and the number of myeloma cells, raised hemoglobin level and improved the ability of self attendance (P< 0.01); the level of vascular endothelial growth factor (VEGF) in treatment group was significantly lower than that of control group (P< 0.01); while the side effects were tolerable.Conclusion:Thalidomide incorporation with VAD applied in multiple myeloma has merits such as less side effects, good tolerance, convenient administration and significant curative effect, it would be valuable to do clinical research and widespread popularization.