硼替佐米为主的化疗方案治疗60例多发性骨髓瘤患者的临床分析

本研究观察硼替佐米联合地塞米松、甲基强的松龙或其它化疗药物治疗初治、复发难治多发性骨髓瘤患者的临床疗效与不良反应。19例初治的多发性骨髓瘤（MM）患者中14例接受硼替佐米联合沙立度胺（BT）治疗，其余5例接受硼替佐米联合甲基强的松龙（B＋MP）治疗。41例复发难治骨髓瘤患者中26例患者接受B＋MP方案治疗，6例接受硼替佐米联合环磷酰胺、强的松、沙立度胺（BCPT）治疗，5例接受硼替佐米联合顺铂、足叶乙甙、环磷酰胺、地塞米松（BDECD）治疗，4例患者接受硼替佐米联合地塞米松（BD）治疗。每例患者至少接受2—8个疗程的治疗。采用Blade标准评价疗效，按照NCI CTCAE标准判断不良反应，中位随访9个月。结果表明：19例初治患者中总有效率18／19（94．7％），其中CR6例（31．6％），NCR6例（31．6％），PR5例（26．3％），MR1例（5．2％）。复发难治者41例中CR5例（12．2％），NCR10例（24．4％），PR14例（34．2％），MR5例（12．2％），总有效率（CR＋nCR＋PR＋MR）82．92％。主要不良反应有乏力，胃肠道症状，周围神经病，不同程度的血小板减少，皮疹及带状疱疹等，经过对症治疗以及调整剂量后均能改善。结论：硼替佐米联合其它药物治疗初治、复发难治多发性骨髓瘤患者是一种安全、可靠、有较好治疗前景的方法。

Bortezomib Combined with Other Drugs for Treating 60 Cases of Multiple Myeloma

The aim of this study was to investigate the efficacy and safety of bortezomib-combined with dexamethasone, methylprednisolone and other drugs in the treatment of patients with multiple myeloma （MM）. 60 MM patients including 19 de novo patients, out of them 14 patients received the treatment using regimen of bortezomib in combination with thalidomide （BT）, 5 patients received bortezomib- methylprednisolone regimen （BMP）. Out of 41 patients with refractory or relapsed myeloma 26 cases of MM received the treatment using regimen of bortezovnib combirned with methylpreamsolone （BMP）, 6 cases received the treatment using regimen of bortezomib combined with cyclophosphamide, predisone and thalidomide （BCPT）, 5 cases received the treatment using regimen of bortezomib combined with cis-diaminodichloroplatimm, etoposide, cydophosphomide and dexame thecson （BDECD）, 4 cases received the treatment using regimen of bortesomib combined with dexamethason （BD）. Each patient received treatment of 2-8 courses at least. Response was assessed according to the criteria of the Blade. Adverse events were graded according to the commom Toxicity Criteria,version 3.0 （NCI CTCAE, USA）. The median follow-up from the start of bortezomib treatment was 9 months. The results showed that out of 19 newly aiagnosed patients, 6 cares acheieved CR, 6 cases acheived nearly CR, 5 cases acheived PR, 1 case acheived MR, resulting in an ORR of 94.7%. Out of 41 refractory or relapsed patients, 5 cases acheieved CR, 10 cases got nearly CR, 14 cases were PR and 5 cases were MR, resuling in an ORR of 82. 92%. The main toxicities were fatigue, gastrointestinal disorders, peripheral neuropathy, thrombocytopenia, herpes zoster, skinrash. All adverse events were diminished by using routine ways. In couclusion, bortezomib combined with orthe drugs is a very effective regimen, its side effects are predictable and manageable.