硼替佐米联合地塞米松和沙利度胺治疗老年多发性骨髓瘤疗效观察

目的观察硼替佐米联合地塞米松和沙利度胺（T-VD）方案治疗老年多发性骨髓瘤患者的有效性和安全性。方法2009年1月-2013年6月共纳人收治的54例多发性骨髓瘤患者，年龄均〉60岁，根据临床使用的不同化学疗法（化疗）方案分为T-VD组和T-VAD组，其中T-VD组25例，T-VAD组29例，T-VAD组采用长春新碱＋蒽环类＋地塞米松＋沙利度胺化疗方案治疗，化疗至少2个周期后评价疗效及不良反应。结果T-VD组总有效率（OR）为84．0％，其中获得完全缓解（CR）＋非常好的部分缓解（vGPR）共计6例（24．0％）；T-VAD组OR为48．3％，其中获得CR＋VGPR共计1例（3．4％），T-VD组OR明显高于T-VAD组（p=7．513，P〈0．05）。主要不良反应有：乏力、恶心、呕吐、骨髓抑制、心脏毒性、周围神经病变；T-VAD组恶心、呕吐反应较T-VD组发生率高（X^2=5．794，P〈0．05）。结论T-VD治疗方案对于老年多发性骨髓瘤患者具有良好的疗效和安全性，建议开展深入研究和推广应用。

Therapeutic Effect of Bortezomib Combined with Dexamethasone and Thalidomide Regimens on Aged Patients withMultiple Myeloma

Objective To investigate the efficacy and safety of bortezomib combined with dexamethasone and thalidomide regimens on aged patients with multiple myeloma. Methods A total of 166 multiple myeloma patients were selected between January 2009 and June 2013; all patients were assigned to regimens of T-VD or T-VAD named T-VD group or T-VAD group （with 25 patients in T-VD group and 29 in T-VAD group）. Efficacies and toxicities were analyzed and compared after two cycles. Results Overall response rate （OR） in T-VD group was 84.0%; there was 6 patients achieved complete response （OR） or very good partial response （VGPR） （24.0%）. However, Overall response rate （OR） in T-VAD group was 48.3%; there was only one patient achieved CR or VGPR （3.4%）; significant difference between two groups was found （2：=7.513, P 〈 0.05）. The major adverse reactions were debilitation, nausea, vomiting, myelo-suppression, cardiac toxicity, and peripheral neuropathy. There were highest incidence of nausea and vomiting in T-VAD group compared to T-VD group （X^2=5.794, P 〈 0.05）. Conclusion Bortezomib combined with dexamethasone and thalidomide regimens is effective and safe, which can be widely used for aged patients with multiple myeloma.