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目的:观察硼替佐米联合地塞米松方案治疗初诊多发性骨髓瘤的疗效及不良反应。方法:硼替佐米组:硼替佐米1.0～1.3mg/(m2·d),3～5s,静脉推注,d1、d4、d8和d11;地塞米松20～40mg/d,静脉滴入,d1～d4、d8～d11,21d为1个周期,进行3～6个周期。传统方案组:主要治疗方案为M2(卡莫司汀+环磷酰胺+美法仑+长春新碱+泼尼松)、VAD(长春新碱+多柔比星+地塞米松),治疗4～6个周期。结果:硼替佐米组10例患者中,CR4例,nCR3例,PR2例,MR1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。主要不良反应为周围神经病变、带状疱疹、乏力和尿潴留。传统方案组32例患者中,CR2例,nCR2例,PR10例,MR6例,NR12例,ORR为62.5%。主要不良反应为恶心、周围神经病变、感染和血小板减少。肾功能损害患者肾功无明显恢复,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差异有统计学意义,P<0.05。结论:硼替佐米联合地塞米松方案治疗初诊多发性骨髓瘤与传统方案相比疗效好、不良反应轻微且可逆。
Objective: To observe the efficacy and adverse reactions of bortezomib plus dexamethasone regimen in the treatment of newly diagnosed multiple myeloma. Methods: The bortezomib group received bortezomib 1.0 ~ 1.3 mg / (m2 · d) for 3 ~ 5 s, iv, d1, d4, d8 and d11, dexamethasone 20 ~ 40 mg / d1 to d4 and d8 to d11 and 21d are one cycle, and three to six cycles are performed. Traditional programs: The main treatment options are M2 (carmustine + cyclophosphamide + melphalan + vincristine + prednisone), VAD (vincristine + doxorubicin + dexamethasone), treatment 4 ~ 6 cycles. Results: Bortezomib group of 10 patients, CR4 cases, nCR3 cases, PR2 cases, MR1 cases. ORR is 100%. Safe and effective for patients with impaired renal function, bone destruction have some recovery. The main adverse reactions were peripheral neuropathy, shingles, fatigue and urinary retention. Of the 32 patients in the traditional regimen, CR2, nCR2, PR10, MR6, NR12, and ORR were 62.5%. The main adverse reactions were nausea, peripheral neuropathy, infection and thrombocytopenia. Renal impairment in patients with renal dysfunction no significant recovery, bone destruction in patients with varying degrees of pain relief, but no significant recovery of imaging. There was significant difference of blood β2-microglobulin, myeloma cells, lactate dehydrogenase and hemoglobin before and after treatment in both groups (P <0.05). Conclusion: Bortezomib combined with dexamethasone regimen has a good curative effect in treating newly diagnosed multiple myeloma compared with the traditional regimen. The adverse reaction is mild and reversible.