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目的观察硼替佐米联合地塞米松和沙利度胺(T-VD)方案治疗老年多发性骨髓瘤患者的有效性和安全性。方法 2009年1月-2013年6月共纳入收治的54例多发性骨髓瘤患者,年龄均>60岁,根据临床使用的不同化学疗法(化疗)方案分为T-VD组和T-VAD组,其中T-VD组25例,T-VAD组29例,T-VAD组采用长春新碱+蒽环类+地塞米松+沙利度胺化疗方案治疗,化疗至少2个周期后评价疗效及不良反应。结果 T-VD组总有效率(OR)为84.0%,其中获得完全缓解(CR)+非常好的部分缓解(VGPR)共计6例(24.0%);T-VAD组OR为48.3%,其中获得CR+VGPR共计1例(3.4%),T-VD组OR明显高于T-VAD组(χ2=7.513,P<0.05)。主要不良反应有:乏力、恶心、呕吐、骨髓抑制、心脏毒性、周围神经病变;T-VAD组恶心、呕吐反应较T-VD组发生率高(χ2=5.794,P<0.05)。结论 T-VD治疗方案对于老年多发性骨髓瘤患者具有良好的疗效和安全性,建议开展深入研究和推广应用。
Objective To observe the efficacy and safety of bortezomib combined with dexamethasone and thalidomide (T-VD) in the treatment of elderly patients with multiple myeloma. METHODS: From January 2009 to June 2013, 54 patients with multiple myeloma were enrolled in this study. All patients were over 60 years old. T-VD and T-VAD groups were divided into two groups according to the different chemotherapeutic regimens , Of which T-VD group 25 cases, T-VAD group 29 cases, T-VAD group with vincristine + anthracycline + dexamethasone + thalidomide chemotherapy regimen, chemotherapy for at least two cycles after the evaluation of efficacy and Adverse reactions. Results The total effective rate (OR) of T-VD group was 84.0%, of which 6 cases (24.0%) had complete response (CR) + very good partial response (VGPR) CR + VGPR was found in 1 case (3.4%). The OR of T-VD group was significantly higher than that of T-VAD group (χ2 = 7.513, P <0.05). The main adverse reactions were: fatigue, nausea, vomiting, myelosuppression, cardiotoxicity and peripheral neuropathy. The incidence of nausea and vomiting in T-VAD group was higher than that in T-VD group (χ2 = 5.794, P <0.05). Conclusion The T-VD treatment regimen has good curative effect and safety for elderly patients with multiple myeloma. It is suggested that further research and application should be carried out.