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目的总结多发性骨髓瘤(multiple myeloma,MM)的发病特征及临床特征,分析比较不同治疗方案对MM的疗效及不同类型与不同临床特征的MM治疗效果。方法回顾性分析2003年1月2008年1月128例MM患者的发病和临床特征,以及与治疗效果的关系,并对不同治疗方案、不同类型间的疗效进行比较。结果 MM患者发病的中位年龄为59岁,临床上以不明原因的骨痛、贫血、感染和球蛋白增高为主要表现。128例患者中行方案一(马法兰、强的松/地塞米松、反应停)的总有效率为53.3%(32/60);方案二(环磷酰胺、长春新碱、马法兰、强的松、卡氮芥、阿霉素)为44.4%(8/18);方案三(长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松)为68.5%(24/35),方案四(硼替佐米、地塞米松/反应停)的总有效率为86.6%(13/15)。方案一和方案二间、方案三和方案四间疗效差异无统计学意义(P>0.05),方案三、方案四的疗效均优于方案一和方案二(P<0.05)。IgG型总有效率为63.2%(48/76),IgA型为60.9%(14/23),kappa轻链型为42.8%(6/14),lammda轻链型为46.2%(6/13)。IgG型和IgA型间的疗效差异无统计学意义(P>0.05),但IgG型、IgA型的疗效均优于kappa轻链型和lammda型(P<0.05)。不同类型及使用不同方案的患者,其中位生存期及3年和5年的生存率差异无统计学意义(P>0.05)。结论 MM患者发病高峰年龄介于40～70岁,骨痛和贫血是最常见的首发症状。长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松以及硼替佐米、地塞米松/反应停方案总体疗效相当,但后者完全缓解率高于前者。
Objective To summarize the incidence and clinical features of multiple myeloma (MM), and to compare the efficacy of different treatment regimens with MM and the therapeutic effects of different types and clinical features of MM. Methods The incidence and clinical features of 128 MM patients from January 2003 to January 2008 were retrospectively analyzed. The relationship between them and the therapeutic effect was also analyzed. The curative effects of different treatment regimens and different types of patients were compared. Results The median age of onset of MM was 59 years old. The main clinical manifestations were unexplained bone pain, anemia, infection and globulin. In 128 patients, the total effective rate was 53.3% (32/60) in case 1 (melphalan, prednisone / dexamethasone, response stop); in case 2, cyclophosphamide, vincristine, melphalan, prednisone, (44.5%, 8/18) in the third regimen (vincristine, doxorubicin / epirubicin / liposomal doxorubicin, dexamethasone) was 68.5% (24 / 35). The total effective rate of program IV (bortezomib, dexamethasone / reaction) was 86.6% (13/15). There was no significant difference in the four curative effects between the first protocol and the second protocol, the third protocol and the fourth protocol (P> 0.05). The curative effects of the third protocol and the fourth protocol were better than the first and second schemes (P <0.05). The total effective rate of IgG was 63.2% (48/76), IgA was 60.9% (14/23), kappa light chain was 42.8% (6/14), lammda light chain was 46.2% (6/13) . There was no significant difference in the therapeutic effect between IgG and IgA (P> 0.05), but both IgG and IgA were superior to kappa light chain and lammda (P <0.05). There was no significant difference in median survival, 3-year and 5-year survival between patients with different types and using different regimens (P> 0.05). Conclusion The onset age of MM patients is between 40 and 70 years old. Pain and anemia are the most common initial symptoms. Vincristine, doxorubicin / epirubicin / liposomal doxorubicin, dexamethasone, and bortezomib, dexamethasone / response to stop the overall response to the program, but the latter complete remission rate was higher than the former.