FND方案治疗难治性、复发性多发性骨髓瘤的初步报告  

Preliminary Report of Fludarabine, Mitoxantrone and Dexamethasone in Treating Refractory or Relapsed Multiple Myeloma

作　　者：罗绍凯[1] 李娟[1] 洪文德[1] 赵莹[1] 童秀珍[1] 

机构地区：[1]中山大学附属第一医院血液科,广州广东510080

出　　处：《癌症》2005年第12期1518-1521,共4页Chinese Journal of Cancer

基　　金：广东省科技计划项目(No.200130303)~~

摘　　要：背景与目的:多发性骨髓瘤(multiplemyeloma,MM)完全缓解率低、复发率高,绝大多数的MM患者经数个联合化疗方案后都会进入难治或复发阶段。本研究旨在观察含氟达拉滨(Fludarabine,Flu)的FND方案(Flu、米托蒽醌、地塞米松)治疗难治和复发性MM的疗效、毒副反应,以期为难治和复发性MM探索出安全有效的治疗方法。方法:将采用VAD方案(长春新碱、吡柔比星、地塞米松)化疗的22例患者作为历史对照组,观察和比较FND组(11例)和VAD组的疗效、达到缓解所需的时间,M蛋白下降50%以上、骨髓涂片中骨髓瘤细胞比例下降80%或占有<5%及血红蛋白上升20g/L的患者例数和时间,化疗后外周血白细胞和血小板的变化,治疗前后血钙、血肌酐、谷丙转氨酶的变化及不良反应。比较FND组治疗前后MM患者血清β2-微球蛋白的变化。结果:FND组的PR率是45.5%(5/11),高于VAD组的22.7%(5/22)(P<0.05),FND组达到PR的中位时间为76天,长于VAD组的68天(P<0.05)。M蛋白下降50%以上、血红蛋白上升20g/L在FND组分别为45.5%(5/11)、54.5%(6/11),均高于VAD组的22.7%(5/11)、18.2%(4/22)(P<0.05)。两组在治疗前后血钙、血肌酐、谷丙转氨酶均无明显变化;FND组治疗后MM患者血清β2-微球蛋白为(1042.8±72.3)μg/L,显著低于治疗前的(2350.2±184.0)μg/L(P<0.05)。FND组白细胞下降最低值为(0.9±0.5)×109/L,明显低于VAD组的白细胞下降的最低值[(2.1±0.6)×109/L](P<0.05);用FND方案治疗MM过程出现发热、咳嗽分别为36.4%(4/11)、45.5%(5/11),高于VAD组(分别为4.5%和9.0%)(P<0.05)。结论:用含Flu的FND方案治疗难治性、复发性多发性骨髓瘤PR率优于VAD组,但FND方案发挥明显疗效的时间较长,对骨髓的抑制较VAD方案显著,无肝肾毒性,是一种有效、安全的治疗难治性、复发性MM的方案。BACKGROUND ＆ OBJECTIVE： Multiple myeloma has low complete remission rate and high recurrence rate. Recurrence or relapse of the disease is almost inevitable for most of the patients after several cycles of combined chemotherapy. This study was designed to compare efficacy of fludarabine-based regimen （fludarabine, mitoxantrone and dexamethasone） with that of pirarubicin, vincristine and dexamethasone （VAD） on refractory or relapsed multiple myeloma, and analyze their toxicities. METHODS： Twenty- two patients who had received VAD regimen were taken as a historical control group. A total of 11 patients received FND regimen. The differences between FND group and VAD group were observed and compared. The following indexes were assessed before, during, and after treatment, the partial remission （PR） rate, total response rate, time to achieve PR, the number of patients and time of serum M-component drop to more than 50% of the pre-reatment value, the ratio of myeloma cells in bone marrow drop to less than 5% or more than 80% of pre-treatment level, and the hemoglobin level increase to more than 20 g/L; the white blood cell and platelet count of the peripheral blood, serum calcium, creatinine, 132-microglobin and glutamic-oxaloacetic transaminase （GPT） level, adverse events were also analyzed. RESULTS： The PR rate was significantly higher in FND group than in VAD group （45.5% vs. 22.7%, P〈0.05）. The median time to achieve PR was significantly longer in FND group than in VAD group （76 days vs. 68 days, P〈0.05）. The occurrence rates of M-component decrease and hemoglobin elevation were significantly higher in FND group than in VAD group [45.5% vs. 22.7%, and 54.5% vs. 18.2%, P〈0.05]. There were no significant differences in serum calcium, creatinine and GPT level pre- and post- treatment between the 2 groups. The level of serum 132-microglobin after treatment was significantly lower than that before treatment in FND group [（1042.8±72.3）μg/L vs. （2350.2±184.0）μg/L, P〈0.05

关 键 词：骨髓瘤 难治性 骨髓瘤 复发性 药物疗法 联合 氟达拉滨/治疗应用 疗效 

分 类 号：R733.3[医药卫生—肿瘤]