雷利度胺为主方案治疗多发性骨髓瘤25例疗效分析

 目的　观察雷利度胺为主方案治疗多发性骨髓瘤（MM）患者的疗效及不良反应。方法　MM患者25例，其中5例为初治患者，13例为含沙利度胺方案治疗后难治、复发患者，7例为治疗后达平台期维持治疗患者。初治MM患者均采用R-PAD方案，难治、复发患者选用R-MD方案，维持治疗MM患者由于出现Ⅱ级伴疼痛以上的周围神经炎（PN），采用雷利度胺单药治疗。结果　初治组5例，经过2个疗程的治疗均达到完全缓解（CR）（100 %）；难治、复发组13例，CR率为23.08 %（3／13），非常好的部分缓解（VGPR）率为15.38 %（2／13），部分缓解（PR）率为38.46 %（5／13），总反应率（ORR）为76.92 %（10／13）；其余3例无反应患者中，2例疾病稳定（SD），1例疾病进展（PD）。维持治疗组7例在平均38周的随访期内均维持缓解；改用雷利度胺后，PN获得不同程度的缓解。结论　对于初治MM患者，R-PAD方案缓解率高，起效快；对于难治、复发患者，特别是伴严重PN的MM患者，R-MD是值得选择的方案；雷利度胺还可用于伴PN的MM患者的维持治疗。

Effectiveness of lenalidomide-based chemotherapy on 25 patients with multiple myeloma

Objective To evaluate the efficacy and safety of lenalidomide(Len)-based regimens in the treatment to patients with multiple myeloma (MM). Methods Twenty-five multiple myeloma patients who received Len-based regimens were enrolled in this study. There were 5 newly-diagnosed MM patients, 13 relapsed/refractory (rel/ref) MM and 7 MM patients at plateau after treatment. The newly-diagnosed patients received R-PAD regimen, rel/ref MM received R-MD and the patients at plateau(maintenance treatment group) due to more than 2 grade peripheral neuropathy (PN) received Len monotherapy. Results All of the five newly-diagnosed MM achieved complete remission (CR) (100 %) after 2 courses of theatment; of 13 rel/ref patients (76.92 %) achieved overall response, including 3 (23.08 %) achieving CR, 2 (15.38 %) very good partial response (VGPR), 5 (38.46 %) partial response (PR) and the overall response rate was 76.92 %. Two of the other three no response patients had stable disease(SD) and one had progress disease(PO). The seven patients in maintenant treatment group maintained remission in an average follow-up period of 38 weeks and their PN was relieved in various degrees. Conclusion R-PAD regimen is a highly active regimen for newlydiagnosed MM and R-MD regimen is a promising regimen for rel/ref MM, especially for the patients with serious PN; Len may be a good choice as maintenant chemotherapy for the patients with PN.