多发性骨髓瘤患者联合酞胺哌啶酮治疗的疗效分析

目的探讨低剂量酞胺哌啶酮联合VAD方案治疗多发性骨髓瘤(MM)的疗效及安全性。方法选择我院收治的MM患者53例,进行酞胺哌啶酮联合VAD方案治疗,4个疗程后进行整体评估。观察治疗前后骨髓增生情况以及骨髓瘤细胞数量,血红蛋白、β_2-微球蛋白、卡氏评分等各项检测指标的变化,分析患者的不良反应。结果 53例患者的总有效率为83.02%,治疗后患者血红蛋白、卡氏评分显著高于治疗前,差异有统计学意义(血红蛋白:t=7.465,P=0.000;卡氏评分:t=12.082,P=0.000)。骨髓浆细胞百分比、β_2-微球蛋白、肌酐、血清球蛋白显著低于治疗前,差异有统计学意义(骨髓浆细胞:t=22.747,P=0.000;β_2-微球蛋白:t=14.442,P=0.000;肌酐:t=2.928,P=0.004;血清球蛋白:t=20.894,P=0.000)。25例轻度嗜睡(47.17%)、6例头晕(11.32%)、38例便秘(71.70%)、30例四肢麻木(56.60%)。25例轻度纳差(47.17%),13例轻度恶心呕吐(24.53%),但均可耐受。结论低剂量酞胺哌啶酮联合VAD方案治疗MM疗效显著,且不良反应少、耐受性好、给药方便,值得临床推广。

Efficacy of the combined treatment of thalidomide for patients with multiple myelo-ma

Objective To investigate the efficacy and safety of the treatment of low-dose thalidomide com-bined with VAD regimen for patients with multiple myeloma (MM). Methods Fifty three patients with MM were treated by thalidomide combined with VAD regimen in our hospital. The assessment was applied after four courses. The bone marrow hyperplasia,number of myeloma cells,hemoglobin,β2-microglobulin,Karnofsky index and other indica-tors were observed before and after treatment,as well as the patient’ s adverse reaction. Results The total effective rate was 83. 02% among 53 patients. The hemoglobin and Karnofsky score after treatment were significantly higher than those before treatment, the differences were significant ( hemoglobin:t = 7. 465, P = 0. 000; Karnofsky score:t =12. 082,P =0. 000). The percentage of bone marrow plasma cells,β2-microglobulin,creatinine and serum globulin were significantly lower than those before treatment,the differences were significant ( bone marrow plasma cells:t =22. 747,P=0. 000; β2-microglobulin:t =14. 442,P =0. 000; creatinine:t =2. 928,P =0. 004;serum Globulin:t =20. 894,P=0. 000). There were 25 patients with mild drowsiness (47. 17%),6 patients with dizziness (11. 32%),38 patients with constipation ( 71. 70%) , 30 patients with limbs numbness ( 56. 60%) , 25 patients with mild anorexia (47. 17%) and 13 patients with mild nausea and vomiting (24. 53%). However,all of the adverse reaction could be tolerated. Conclusion The efficacy of the treatment of low-dose thalidomide combined with VAD regimen is signifi-cant with the advantages of fewer adverse reaction,good tolerability and easy administration. It is worthy of application in clinics.