沙利度胺联合MP化疗方案治疗多发性骨髓瘤的疗效评价

目的 比较单用MP方案(马法兰加强的松,对照组)与MP联合沙利度胺方案(治疗组)治疗多发性骨髓瘤(MM)的临床疗效和不良反应.方法 治疗组:18例.沙利度胺起始剂量100mg/d,每2周剂量递增50mg/d,直至200mg/d维持治疗;同时联合MP方案化疗(马法兰8mg/m2,d1-4,强的松2mg/kg,d1-4),每月1个疗程.对照组:21例.马法兰、强的松的剂量和用法同治疗组.两组患者在第4个疗程结束后判断疗效.数据采用SPSS软件分析.结果 治疗组治疗后较治疗前平均血红蛋白浓度升高26.9%、骨髓瘤细胞百分比下降73.2%、IgG下降50.0%、IgA下降84.7%;治疗前后比较,P值分别为0.02、 0.047、0.183、0.047.对照组治疗后较治疗前平均血红蛋白浓度升高22.8%、骨髓瘤细胞百分比下降62.8%、IgG下降32.0%;治疗前后比较,P值分别为0.985、0.001、0.966.治疗组总有效率为72.22%(13/18),对照组总有效率为47.62%(10/21),两组间差异有统计学意义(P＜0.05).治疗组皮疹、便秘、嗜睡和水肿较对照组多,其他不良反应两组差异无统计学意义.结论 沙利度胺联合MP方案治疗MM较单用MP方案疗效更明显,患者耐受性好.

Clinical efficacy of thalidomide plus melphalan and prednisone in treatment of multiple myeloma

Objective To explore the efficacy and toxicity of patients with multiple myeloma(MM) treated with melphalan and prednisone(MP) regimen alone(the control group) compared with thalidomide plus MP regimen(the treated group).Methods Eeighteen patients in the treated group were initially admimistered thalidomide at dose of 100mg/d,then increased 50mg/d to 200mg/d every two weeks.Chemotherapy with melphalan 8mg/m2 daily and oral prednison 2mg/kg daily for 4d was acconpanied in all patients,each cycle lasted for one month.Twenty-one cases in the control group received chemotherapy with MP regimen alone.After 4 courses of treatment,the effects and side effects of the two groups were evaluated.Results In the treated group,after treatment,the serum Hb increased by 26.9% compared with that before treatment,myeloma cells decreased 73.2%,lgG decreased 50.0%,IgA decreased 84.7% after treatment,in the analysis,the P values were 0.02,0.047,0.183,0.047 respectively.In the control group,after treatment,the serum Hb increased by 22.8% compared with that before treatment,myeloma cells decreased 62.8%,lgG decreased 32.0% after treatment,in the analysis,the P values were 0.985,0.001,0.966 respectively.The total response rate was 72.22%(13/18) and 47.62%(10/21) in the treated group and in the control group,respectively,which demonstrated a significant difference(P<0.05).The main side effects in the treated group were skin rash,constipation,somnolence and edema.Conclusion Thalidomide plus MP regimen is more effective than MP regimen alone in the treatment of MM,and it is well tolerable.