目的:评价以波替单抗为主的2种化疗方案治疗多发性骨髓瘤(MM)的安全性。方法:应用不良事件标准(3.0版)对分别用PAD和VMP方案治疗的MM患者出现的不良反应进行回顾性总结分析。PAD方案:波替单抗+盐酸表柔比星+地塞米松,4个疗程,第1疗程18 d,第2～4疗程各11 d;适用于身体状况尚可、年龄较轻的MM患者。VMP方案:波替单抗+美法仑+泼尼松,4个疗程,每个疗程均11 d;适用于身体状况较差、年龄较大的MM患者。结果:2008年3月至2010年12月,共16例MM住院患者在空军总医院接受化疗。接受PAD方案者12例,男7例,女5例,中位年龄61岁;接受MVP方案者4例,男3例,女1例,中位年龄67岁。PAD与VMP方案导致的主要不良反应为血小板减少、中性粒细胞减少、周围神经病变、感染和消化道反应。(1)接受PAD方案者有9例在第2～4疗程血小板减少,其中Ⅰ～Ⅱ级7例,Ⅲ级和Ⅳ级各1例;接受VMP方案者有2例血小板减少,Ⅱ级1例,Ⅳ级1例。上述患者均持续PAD或VMP治疗未停药,Ⅲ级和Ⅳ级者输注血小板后血小板计数恢复正常。(2)接受PAD方案者有8例在第2～4疗程中性粒细胞降低,Ⅰ～Ⅱ级5例,Ⅲ级1例,Ⅳ级2例。接受VMP方案者有2例在第2～4疗程中性粒细胞降低,Ⅱ级1例,Ⅳ级1例。Ⅰ～Ⅱ级者均持续治疗未停药。接受PAD方案Ⅲ级者暂时停药给予对症治疗,中性粒细胞计数恢复正常后继续治疗。接受VMP方案Ⅳ级者未停药,皮下注射重组人粒细胞刺激因子。(3)接受PAD方案者有4例出现周围神经病变,Ⅰ～Ⅱ级3例,Ⅲ级1例。接受VMP方案者有1例出现Ⅰ级周围神经病变。1例Ⅱ级者经调整波替单抗剂量(由1.3 mg/m2减至1.0 mg/m2)后好转;1例Ⅲ级者经停药和对症治疗后恢复PAD方案;其他患者均未停药。(4)接受PAD方案者有4例在第2～4疗程出现发热和感染,1例因肺部感染发生感染性休克死亡。(5)16例患者均出现食欲减退、恶心、呕吐、腹泻或便秘,均未停药并予对症治疗。结论:PAD与VMP方案治疗MM均较安全,大多不良反应为轻度能耐受。对较严重的不良反应应停药或调整波替单抗的剂量。 PURPOSE: To evaluate the safety of two chemotherapy regimens, predominated by tauitromumab, in the treatment of multiple myeloma (MM). METHODS: Adverse events were retrospectively analyzed using the Adverse Events Standard (version 3.0) in patients with MM treated with PAD and VMP regimens. PAD program: warfarin + epirubicin hydrochloride + dexamethasone, four courses, the first course of 18 days, the first two courses of treatment of 11 d; for the body condition is acceptable, younger patients with MM . VMP program: warfarin + melphalan + prednisone, four courses, each course of 11 d; for poor health, older patients with MM. Results: From March 2008 to December 2010, a total of 16 MM inpatients were treated at the Air Force General Hospital. There were 12 males and 7 females and 5 females receiving PAD regimen. The median age was 61 years. Four patients underwent MVP regimen including 3 males and 1 females, with a median age of 67 years. The main adverse reactions caused by PAD and VMP regimens were thrombocytopenia, neutropenia, peripheral neuropathy, infection and gastrointestinal reactions. (1) Nine patients underwent PAD regimen in thrombocytopenia during courses 2 to 4, including 7 cases of grade Ⅰ ~ Ⅱ, 1 case of grade Ⅲ and Ⅳ, 2 cases of thrombocytopenia and 1 case of grade Ⅱ , Grade Ⅳ in 1 case. All patients continued PAD or VMP treatment without stopping, Ⅲ and Ⅳ grade platelet transfusion after platelet count returned to normal. (2) There were 8 cases who received PAD regimen in the 2nd to 4th courses of neutrophil reduction, Ⅰ ~ Ⅱ grade in 5 cases, Ⅲ grade in 1 case, Ⅳ grade in 2 cases. In VMP regimen, 2 patients had neutrophils decreased in the second to the fourth courses, one in grade Ⅱ and one in grade Ⅳ. Ⅰ ~ Ⅱ-level treatment were continued without stopping. Patients who received PAD regimen grade III were temporarily given symptomatic treatment and neutrophil count returned to normal after treatment. Patients receiving VMP regimen grade IV did not stop their treatment and injected recombinant human granulocyte-stimulating factor subcutaneously. (3) Peripheral neuropathy occurred in 4 patients receiving PAD, 3 in grade Ⅰ ~ Ⅱ and 1 in grade Ⅲ. One patient who underwent VMP regimen developed grade 1 peripheral neuropathy. 1 patient in grade Ⅱ improved after treatment with tocotrion (1.3 mg / m 2 reduced to 1.0 mg / m 2); one patient in grade Ⅲ recovered PAD after discontinuation and symptomatic treatment; the other patients did not stop taking drug . (4) 4 patients who received PAD regimen experienced fever and infection at the 2nd to 4th courses of treatment, and 1 died of septic shock due to pulmonary infection. (5) All 16 patients experienced loss of appetite, nausea, vomiting, diarrhea or constipation, and did not stop the treatment and were given symptomatic treatment. Conclusion: The treatment of MM with PAD and VMP is safer, and most of the adverse reactions are mild with tolerance. For more serious adverse reactions should be discontinued or adjust the dose of tauitizumab.