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目的分析多发性骨髓瘤(MM)的细胞遗传学变化及其与蛋白酶体抑制剂治疗的关系。方法对2005年1月至2006年7月北京大学人民医院29例初诊的MM患者行染色体核型检查,采用骨髓细胞24h短期培养,用常规方法制备染色体,G显带进行核型分析。22例MM患者采用传统化疗即长春新碱联合阿霉素和地塞米松(VAD)方案或马法兰与泼尼松(MP)方案;7例患者应用蛋白酶体抑制剂(硼替佐米)为主的化疗方案。比较两组患者的有效率及缓解率。结果29例MM患者中异常核型检出率为37.9%,其中有复杂和高度复杂畸变的占81.8%。采用VAD或MP方案化疗的核型正常组的有效率为81.2%,核型异常组有效率为0,差异有显著性意义(P<0.05)。应用硼替佐米为主的化疗方案中核型异常组5例均有效,核型正常组2例均有效。核型异常组硼替佐米有效率与传统化疗组相比,差异有显著性意义(P<0.05)。结论染色体核型异常的患者,应首选蛋白酶体抑制剂硼替佐米等进行治疗。
Objective To analyze the cytogenetic changes in multiple myeloma (MM) and its relationship with proteasome inhibitor therapy. Methods From January 2005 to July 2006, 29 newly diagnosed MM patients in Peking University People ’s Hospital underwent chromosome karyotype examination. The bone marrow cells were cultured for 24 hours. Chromosomes and G - banding karyotype were analyzed by conventional methods. Twenty-two MM patients underwent chemotherapy with vincristine combined with doxorubicin and dexamethasone (VAD) or melphalan and prednisone (MP) regimens; seven patients were predominated with proteasome inhibitor (bortezomib) Chemotherapy. The effectiveness and remission rate of the two groups were compared. Results The detection rate of abnormal karyotype in 29 MM patients was 37.9%, of which 81.8% were complicated and highly complicated. The effective rate of karyotype normal group treated with VAD or MP regimen was 81.2%, and the effective rate of karyotype abnormal group was 0, the difference was significant (P <0.05). In the bortezomib-based chemotherapy regimen, 5 cases were both effective in karyotype abnormalities and 2 cases in normal karyotype. Compared with the traditional chemotherapy group, the effective rate of bortezomib in karyotype abnormalities group was significantly different (P <0.05). Conclusion Chromosome karyotype abnormalities should be the first choice of proteasome inhibitor bortezomib for treatment.