论文部分内容阅读
目的比较硼替佐米联合地塞米松与M2、VAD等传统化疗方案治疗Ⅲ期多发性骨髓瘤(multiple myeloma,MM)的疗效及安全性。方法31例MM患者,临床分期均属于Ⅲ期。11例患者(5例初治及6例复发/难治)选择硼替佐米联合地塞米松治疗,20例患者(7例初治及13例复发/难治)选择M2、VAD、MP±V方案治疗。采用EBMT标准判定疗效,并按WHO标准判断不良反应。结果(1)硼替佐米联合地塞米松组:CR 27.3%(3/11),PR 36.4%(4/11),MR 27.3%(3/11),NC9.1%(1/11),总有效率为90.9%,其中初治患者CR 20.0%(1/5),PR 20.0%(1/5),MR 40.0%(2/5),NC 20.0%(1/5),有效率为80.0%;复发/难治患者CR 33.3%(2/6),PR 50.0%(13/6),MR16.7%(1/6),有效率为100%。(2)传统化疗方案组:PR 30.0%(6/20),MR 15.0%(3/20),PD10.0%(2/20),SD 45.0%(9/20),总有效率为45.0%,其中初治患者PR 42.6%(3/7),MR 28.6%(2/7),PD 14.3%(1/7),SD 14.3%(1/7),有效率71.4%;复发/难治患者PR 23.1%(3/13),MR7.7%(1/13),PD 7.7%(1/13),SD 61.5%(8/13),有效率为30.8%。χ2检验结果显示,两组方案对于初治及复发/难治患者的总疗效差异有显著性(P<0.05)。与传统化疗方案相比,硼替佐米联合地塞米松方案副作用轻微,包括乏力、指端麻木、胃肠道反应等,无严重血液学毒性及心脏毒性,安全性较好。结论硼替佐米联合地塞米松是一种新的有效治疗MM的方案,Ⅲ期初治及复发/难治患者均可明显受益,达到一定的临床缓解。该方案不良反应轻微,患者均能耐受。
Objective To compare the efficacy and safety of bortezomib with dexamethasone and traditional chemotherapy regimens such as M2 and VAD in the treatment of stage Ⅲ multiple myeloma (MM). Methods 31 patients with MM, the clinical stage are Ⅲ. Bortezomib and dexamethasone were used in 11 patients (5 patients were initially treated and 6 patients were relapsed / refractory). M2, VAD and MP ± V were selected in 20 patients (7 initially treated and 13 relapsed / refractory) Program treatment. EBMT criteria to determine efficacy, and according to WHO standards to determine adverse reactions. Results (1) Bortezomib combined with dexamethasone group: CR 27.3% (3/11), PR 36.4% (4/11), MR 27.3% (3/11), NC 9.1% The total effective rate was 90.9%. Among them, 20.0% (1/5) in CR, 20.0% (1/5) in PR, 40.0% (2/5) in MR, and 20.0% 80.0%; CR 33.3% (2/6), PR 50.0% (13/6), MR 16.7% (1/6) in the relapsed / refractory patients, the effective rate was 100%. (2) Traditional chemotherapy group: PR 30.0% (6/20), MR 15.0% (3/20), PD10.0% (2/20), SD 45.0% (9/20), and the total effective rate was 45.0 Among them, PR 42.6% (3/7), MR 28.6% (2/7), PD 14.3% (1/7), SD 14.3% (1/7), effective rate 71.4% PR 23.1% (3/13), MR7.7% (1/13), PD 7.7% (1/13), and SD 61.5% (8/13), with an effective rate of 30.8%. The results of χ2 test showed that there was a significant difference (P <0.05) between the two groups in the total curative effect of the newly diagnosed and relapsed / refractory patients. Compared with traditional chemotherapy, bortezomib combined with dexamethasone side effects of the program minor, including fatigue, finger numbness, gastrointestinal reactions, no serious hematological toxicity and cardiotoxicity, better safety. Conclusion Bortezomib combined with dexamethasone is a new and effective treatment of MM. The initial treatment of stage Ⅲ and the patients with recurrent / refractory disease can all benefit significantly and achieve certain clinical remission. Adverse reactions to the program mild, patients can tolerate.