硼替佐米为主的联合化疗方案加或不加造血干细胞移植治疗多发性骨髓瘤疗效分析

目的 观察以硼替佐米为主的联合化疗方案加或不加造血干细胞移植(SCT)治疗多发性骨髓瘤(multiple myeloma,MM)患者的疗效及不良反应.方法 31例初治或复发(难治)MM患者接受硼替佐米为主治疗.之后有6例患者接受SCT治疗.按照EBMT标准评价疗效,WHO标准判断不良反应.结果 ①有5例患者由于急性肾功能衰竭、肿瘤溶解综合征等原因终止治疗,其中3例死亡.可以统计疗效的26例患者共完成了99个疗程的治疗,总有效率(ORR)为80.8%.15例初治患者的ORR为100.0%.11例复发(难治)患者的ORR为54.6%.②15例初治患者中有7例完成了8个疗程的治疗,动态观察发现随着疗程的延长疗效不断提高.③6例初治患者化疗达完全缓解(CR)或接近CR(mCR)后行SCT治疗,其中1例复发,5例随访至移植后6～11个月仍持续CR.未采取SCT巩固的9例初治患者中除1例持续CR外有6例在停药后1～3个月复发或进展,2例失访.④多数治疗相关不良反应为l～2级,有3例患者因为末梢神经炎、窦性心动过缓等原因降低硼替佐米的用量,5例因严重不良反应终止治疗.结论 硼替佐米治疗初治及复发(难治)MM疗效肯定,但可能需要进行巩固治疗(如SCT)以维持疗效.硼替佐米不良反应多数轻微且可以耐受,但也应注意少见的严重不良反应.

Outcome of bortezomib plus chemotherapy with or without stem cell transplantation for treatment of multiple myeloma

Objective To investigate the efficacy and adverse reaction of bortezomib plus chemother-apy with or without stem cell transplantation(SCT)for treatment of multiple myeloma(MM).Methods Thirty-one MM patients were treated with bortezomib plus dexamethasone or thalidomide or DTPACE,foIlowed by SCT.Response to bortezomib was evaluated according to the European Blood and Marrow Transplantation (EBMT)criteria.Adverse events were graded according to the wHO criteria.Results ①5 discontinued the bortezomib therapy because of acute renal failure or acute tumor lysis syndrome and 3 died.In 26 evalu-able patients received 99 courses of therapy.The overall response rate(ORR)to bortezomib was 80.8％,and was 100.0％in 15 newly diagnosed patients and 54.6％in 11 relapsed/refractory patients.AIl of the 6 newly diagnosed patients treated with bortezomib plus DTPACE followed by SCT achieved CR.②In 7 newly diagnosed patients completed 8 cycles bortezomib treatment,the diseases were improved more and more with the courses of treatment.Chromosome 13 deletion did not exert a negative impact on response.③6 of 7 pa-tients completed 8 cycles treatment without SCT relapsed in 1～3 month after discontinued therapy：only 1 of 6 such patients received SCT relapsed with the rest keeping on CR at 6～11 month follow-up.④The most common adverse events were 1～2 grade and tolerable 3 patients had to reduce the bortezomib dosage because of peripheral neuropathy or sinus bradycardia.Conclusion Bortezomib in combination with chemotherapy with or without SCT is an effective therapy with manageable toxicities for MM patients.