PCD方案与VAD方案治疗多发性骨髓瘤的临床观察

  目的  探讨硼替佐米+环磷酰胺+地塞米松（PCD方案）和长春新碱+表阿霉素+地塞米松（VAD方案）治疗多发性骨髓瘤的临床疗效及不良反应。  方法  回顾天津市第一中心医院血液科2011年1月至2013年1月收治的多发性骨髓瘤患者41例，依治疗方案不同分为PCD组及VAD组，分析两组患者的疗效及不良反应。  结果  PCD组治疗后部分缓解及以上的有效率达42.9%，而VAD组仅15.0%，差异有统计学意义（P < 0.05），在初治患者中反应良好的患者（CR和VGPR）PCD组为50.0%，VAD组7.7%，差异有统计学意义（P < 0.05），两组患者在疱疹感染、血细胞减少及乏力腹胀等方面的不良反应无明显差异，但PCD组的神经毒性的发生率较VAD组高，差异有统计学意义（P < 0.05）。  结论  PCD方案治疗多发性骨髓瘤疗效优于VAD方案，特别是对于初治患者PCD方案能明显提高缓解率，但治疗过程中应注意硼替佐米的神经毒性，必要时应减量应用。 

Clinical observation on PCD and VAD regimens for multiple myeloma

  Objective  To compare the efficacy and adverse effects of bortezomib+cyclophosphamide+dexamethasone (PCD) and vincristine+adriamycin+dexamethasone (VAD) regimens in multiple myeloma (MM).  Methods  A total of 41 patients with MM were analyzed retrospectively and divided into two groups according to their treatment protocols: PCD group (21 cases) and VAD group (20 cases). Clinical effects and adverse effects were observed in both groups. Patients accepted two to four cycles of PCD or VAD regimens.  Results  In the PCD group, three patients achieved complete remission (CR), three patients had very good partial remission (VGPR), three patients were under partial remission (PR), eight patients had stable disease status (SD), and four patients had progressive disease (PD). In the VAD group, none achieved CR, one patient had VGPR, two patients were under PR, nine patients had SD status, and nine patients had PD. The rate of patients who achieved efficacy (CR+VGPR+PR) in the PCD group was 42.9%, which was higher than that of the VAD group (15.0%). The rate of newly diagnosed patients who achieved good efficacy (CR+VGPR) in the PCD group was 50%, which was higher than that of the VAD group (7.7%). The incidence of herpes infection, cytopenia, fatigue, and gastrointestinal symptoms was similar in the two groups, whereas the incidence of neurotoxicity in the PCD group was higher than that of the VAD group.  Conclusion  The response rate of PCD is higher compared with that of conventional VAD chemotherapy, especially in newly diagnosed MM. PCD may improve CR and VGPR rates and may bring about more severe toxicities, such as neuropathy.