VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析

目的探讨VCD方案联合乌苯美司治疗多发性骨髓瘤(MM)的临床疗效,并分析预后影响因素。方法回顾性收集我院2015年4月~2019年6月收治的96例MM患者资料,根据治疗方法不同分为VCD组47例、联合组49例,均给予VCD方案(硼替佐米+环磷酰胺+地塞米松)化疗,联合组化疗期间连续服用乌苯美司。3个化疗周期后观察疗效,测定生化指标变化,并统计不良反应及预后情况。结果联合组疾病缓解率为77.55%,明显高于VCD组(P<0.05)。与治疗前相比,两组治疗后骨髓中浆细胞比例、血清M蛋白明显降低,血红蛋白(Hb)显著升高(P<0.05),但联合组改善效果优于VCD组(P<0.05)。不良反应有便秘、嗜睡、感染性发热、骨髓抑制等,但均以I~II级为主,且两组不良反应发生率均无统计学差异(P>0.05)。2年总体生存(OS)率、无进展生存(PFS)率分别为76.04%、61.46%,单因素分析显示ISS分期、治疗方案、治疗疗效均与OS率、PFS率有关(P<0.05),COX多因素分析显示ISS分期、治疗方案、治疗疗效均为影响OS率的危险因素(P<0.05),仅治疗疗效是影响PFS率的危险因素(P<0.05)。结论在VCD方案化疗基础上联合乌苯美司治疗MM可有效提高疗效、改善预后;除治疗方案以外,ISS分期、治疗疗效均为影响预后的独立因素。

Analysis on Curative Effect of VCD Regimen Combined with Ubenimex on Multiple Myeloma and Factors Influencing Prognosis

Objective To explore clinical curative effect of VCD combined with ubenimex on multiple myeloma(MM)and to analyze influencing factors of prognosis.Methods The data of 96 MM patients who were admitted to the hospital from April 2015 to June 2019 were retrospectively collected.According to different treatment methods,they were divided into VCD group(47 cases)and combination group(49 cases).All patients were given VCD(velcade,cyclophosphamide,dexamethasone)regimen for chemotherapy.They were given continuous administration of ubenimex during chemotherapy in combination group.After 3 cycles of chemotherapy,curative effect was observed.The changes in biochemical indexes were measured.Adverse reactions and prognosis were statistically analyzed.Results The disease remission rate in combination group was significantly higher than that in VCD group(77.55%vs 57.45%)(P<0.05).Compared with those before treatment,plasmocyte proportion and serum M protein in bone marrow of both groups were significantly decreased,while hemoglobin(Hb)was significantly increased(P<0.05).The improvement effect in combination group was better than that in VCD group(P<0.05).There were adverse reactions such as constipation,lethargy,infectious fever and bone marrow suppression,all mainly on levelⅠ-Ⅱ.There was no significant difference in incidence between the two groups(P>0.05).Of the 96 patients,2-year overall survival(OS)rate and progression-free survival(PFS)rate were 76.04%and 61.46%,respectively.Univariate analysis showed that ISS staging,treatment regimen and curative effect were correlated with OS rate and PFS rate(P<0.05).COX multivariate analysis showed that ISS staging,treatment regimen and curative effect were all risk factors influencing OS rate(P<0.05).Only curative effect was the risk factor influencing PFS rate(P<0.05).Conclusion VCD regimen combined with ubenimex in treatment of MM can effectively improve clinical curative effect,adjust levels of biochemical indexes,and improve prognosis without increasing adverse reactions.In addition to treatment regimen,ISS staging and curative effect are also independent factors influencing prognosis.