硼替佐米联合改良VAD方案治疗多发性骨髓瘤疗效观察

目的:观察硼替佐米联合改良VAD方案（PVAD）治疗多发性骨髓瘤（multiple myeloma）的疗效和安全性。方法:共有52例MM患者接受了2~8个疗程PVAD方案化疗。PVAD方案:硼替佐米（万珂）1.3mg/m2，3秒内快速注射，d1,4,8,11；长春瑞滨10mg/d 静滴，d1~4；吡柔比星10mg/d 静滴，d1~4；地塞米松20mg/d 静滴，d1~4。每28天为1个疗程，观察疗效和不良反应。结果:总体反应率［完全缓解（CR）+接近完全缓解（nCR）+部分缓解（PR）+轻微反应（MR）］为92.3%（48/52），治疗有效率（CR+PR）为88.5%（46/52）。其中在PVAD方案治疗前接受过VAD方案治疗的21例患者中，18例有效，治疗有效率（CR+PR）为85.7%（18/21）。最常见的血液系统不良反应包括白细胞减少、贫血、血小板减少。非血液系统不良反应主要为乏力、外周神经病变、腹胀/便秘等消化道症状、带状疱疹、呼吸道感染、血栓形成等，经对症处理后均可缓解或恢复。结论:PVAD方案在初发或难治复发的多发性骨髓瘤中均有较好疗效，且具有良好的安全性和耐受性。优于单用硼替佐米或单用VAD方案。

Effect of bortizomib in combination with modified VAD chemotherapy on multiple myelo-ma

Objective:To observe the therapeutic effect and safety of bortizomib combined with modified VAD regimen in treatment of patients with multiple myeloma(MM).Methods:All of the 52 patients diagnosed of MM were treated with bortizomib combined with modified VAD regimen for two to eight courses.The regimen was consisted of bortizomib,1.3mg/m2 by jet injection,d1,4,8,11,vinorelbine,10mg/d,by intravenous continuous infusion,d1~4,pirarubicin,10mg/d,by intravenous continuous infusion,d1~4,dexamethasone,20mg/d,by intravenous continuous infusion,d1~4.Twenty-eight days was as one course of treatment.Results:The overall reaction rate(CR+nCR+PR+MR) was 92.3 %（48/52）,and the overall response rate（CR+PR）was 88.5 %（46/52）.Among them,21 patients ever accepted sole modified VAD regimen,and the overall response rate was 85.7 %（18/21）.The main hematologic toxicities were leucocytopenia,anemia and thrombocytopenia.Nonhematologic toxicities were included anergy,peripheral neuropathy,abdominal distension/constipation,herpes zoster,respiratory tract infections,thrombosis etc.They were all well tolerated.Conclusion:The regimen of bortizomib combined with modified VAD is effective and safe for newly diagnosed or refractory and relapsed MM patients,and the results are better than the single rigmen of bortizomib or modified VAD.