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目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的:观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80g/L～100g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果:rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为69.27±3.18(P<0.05)和72.16±2.83(P<0.01)与58.35±2.89和57.76±3.24。6月后,rHuEPO组平均每例直接费用成本10754.40元,明显低于输血组需要达到同样效果所需的每例20704.20元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。
OBJECTIVE: About 80% of patients with Multiple Myeloma (MM) have anemia, and most patients are clinically correct for anemia by transfusion. Recombinant human erythropoietin (rHuEPO) for the treatment of anemia in patients with MM despite the effective, but at what dose, the application of long duration of effect is inconclusive. Objective: To observe the effect and effect of continuous use of high-dose rHuEPO on anemia in MM patients. Methods: Eighty-seven patients with multiple myeloma diagnosed anemia were treated with 40 000 recombinant human erythropoietin daily for 5 days. Subsequent injections were given once a week for 40,000 subcutaneous injections , Intermittent iron supplements. Ninety patients in the control group who were diagnosed with multiple myeloma who were hospitalized in the same period were given blood transfusion to correct their anemia when the symptoms of anemia were obvious or the hemoglobin level was less than 60g / L. The hemoglobin level of most patients was maintained at 80g / L ~ 100g / L or more. Two groups of patients with chemotherapy programs do not make special provisions throughout the study observation period in June. Results: In the rHuEPO group, hemoglobin began to rise two weeks after rHuEPO administration, with a median response time of 16 days. From January to February, hemoglobin increased to the normal level and reached the median of normal hemoglobin level for 51 days. At 3 months and 6 months after the study, the index of life happiness in the rHuEPO group was significantly higher than those in the transfusion group (69.27 ± 3.18 and 72.16 ± 2.83, respectively, P <0.01) and 58.35 ± 2.89 and 57.76 ± 3.24.6 months later, the average cost per direct case of rHuEPO group was 10754.40 yuan, which was obviously lower than the 20704.20 yuan needed for transfusion group needed to achieve the same effect. Conclusions: High dose rHuEPO is superior to blood transfusion in treating MM related anemia, which has rapid onset and good curative effect. The patients’ life happiness is improved obviously, the cost is low, and the safety is better.