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目的观察羟基喜树碱(HCPT)联合MP方案治疗多发性骨髓瘤的临床疗效及不良反应并初步探讨其作用机制。方法 MP方案组:马法兰总量50 mg(2 mg po tid d1~3+2 mg po qid d4~7),共7 d;强的松60 mg po qd,共7 d;HCPT+MP方案组(HMP组):HCPT5 mg,静滴,qd,共7~10 d;联合MP方案7 d(具体同前)同时使用。7~10 d为1个疗程,间隔28 d开始下1个疗程,共6个疗程。结果 HMP组20例患者中,CR 8例,nCR 6例,PR 4例,MR 2例,ORR为100%。对伴有肾功能损害患者安全有效,对骨破坏有一定的恢复作用。MP方案组32例患者中,CR 2例,nCR 2例,PR 10例,MR 6例,NC 12例,ORR为62.5%。肾功能损害患者肾功能无明显恢复,骨破坏患者骨痛有不同程度缓解但影像学未见明显恢复。两组患者主要不良反应均为骨髓抑制、感染和消化道反应,但不良反应的发生率相当(P>0.05)。两组治疗前、后血β2微球蛋白、骨髓瘤细胞、乳酸脱氢酶及血红蛋白变化及血清IL-6、TNF-α含量比较,差异有统计学意义(P<0.05)。结论 HCPT联合MP方案治疗初诊多发性骨髓瘤与传统MP方案相比疗效好,不良反应发生率相当。
Objective To observe the clinical efficacy and adverse reactions of hydroxycamptothecin (HCPT) combined with MP regimen in the treatment of multiple myeloma and to explore its mechanism. Methods MP group: total amount of melphalan 50 mg (2 mg po tid d1 ~ 3 +2 mg po qid d4 ~ 7) for 7 days; prednisone 60 mg po qd for 7 days; HCPT + MP group HMP group): HCPT 5 mg, intravenous infusion, qd, a total of 7 ~ 10 d; combined MP program 7 d (specifically with the former) at the same time. 7 ~ 10 d for a course of treatment, interval 28 d start a course of treatment, a total of 6 courses. Results Of the 20 patients in the HMP group, 8 were CR, 6 were nCR, 4 were PR, and 2 were MR. The ORR was 100%. Safe and effective for patients with impaired renal function, bone destruction have some recovery. Of the 32 patients in the MP regimen, 2 were CR, 2 were nCR, 10 were PR, 6 were MR, and 12 were NC. The ORR was 62.5%. Renal dysfunction in patients with no significant recovery of renal function, bone destruction in patients with varying degrees of bone pain relief but no significant recovery of imaging. The main adverse reactions in both groups were myelosuppression, infection and gastrointestinal reactions, but the incidence of adverse reactions was similar (P> 0.05). The changes of blood β2 microglobulin, myeloma cells, lactate dehydrogenase and hemoglobin, serum IL-6, TNF-α levels in the two groups before and after treatment were significantly different (P <0.05). Conclusions HCPT combined with MP regimen is effective in treating newly diagnosed multiple myeloma compared with traditional MP regimen, with a similar incidence of adverse reactions.