硼替佐米联合地塞米松治疗Ⅲ期多发性骨髓瘤临床观察  

Bortezomib in combination with dexamethasone for the treatment of stage-Ⅲ multiple myeloma

作　　者：苏楠[1] 于锦香[1] 李艳[1] 何娟[1] 吕晓毅[1] 王柏勋[1] 翟明[1] 

机构地区：[1]中国医科大学附属第一医院血液科,沈阳110001

出　　处：《中国肿瘤临床与康复》2009年第2期146-150,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的比较硼替佐米联合地塞米松与M2、VAD等传统化疗方案治疗Ⅲ期多发性骨髓瘤(multiple myeloma,MM)的疗效及安全性。方法31例MM患者,临床分期均属于Ⅲ期。11例患者(5例初治及6例复发/难治)选择硼替佐米联合地塞米松治疗,20例患者(7例初治及13例复发/难治)选择M2、VAD、MP±V方案治疗。采用EBMT标准判定疗效,并按WHO标准判断不良反应。结果(1)硼替佐米联合地塞米松组:CR 27.3%(3/11),PR 36.4%(4/11),MR 27.3%(3/11),NC9.1%(1/11),总有效率为90.9%,其中初治患者CR 20.0%(1/5),PR 20.0%(1/5),MR 40.0%(2/5),NC 20.0%(1/5),有效率为80.0%;复发/难治患者CR 33.3%(2/6),PR 50.0%(13/6),MR16.7%(1/6),有效率为100%。(2)传统化疗方案组:PR 30.0%(6/20),MR 15.0%(3/20),PD10.0%(2/20),SD 45.0%(9/20),总有效率为45.0%,其中初治患者PR 42.6%(3/7),MR 28.6%(2/7),PD 14.3%(1/7),SD 14.3%(1/7),有效率71.4%;复发/难治患者PR 23.1%(3/13),MR7.7%(1/13),PD 7.7%(1/13),SD 61.5%(8/13),有效率为30.8%。χ2检验结果显示,两组方案对于初治及复发/难治患者的总疗效差异有显著性(P<0.05)。与传统化疗方案相比,硼替佐米联合地塞米松方案副作用轻微,包括乏力、指端麻木、胃肠道反应等,无严重血液学毒性及心脏毒性,安全性较好。结论硼替佐米联合地塞米松是一种新的有效治疗MM的方案,Ⅲ期初治及复发/难治患者均可明显受益,达到一定的临床缓解。该方案不良反应轻微,患者均能耐受。Objective To compare the efficacy and safety of bortezomib-dexamethasone vs traditional chemotherapy regimens （such as M2, VAD, MP ± V） in treatment of stage-Ⅲ multiple myeloma （MM）. Methods Thirty-one patients with stage-Ⅲ MM were studied. Eleven patients （5 were newly diagnosed,and 6 were relapsed/refractory） received the regimen of bortezomib in combination with dexamethasone; other 20 （7 were newly diagnosed, and 13 were relapsed/refractory） received the traditional chemotherapy regimens. EBMT and WHO criteria were used to assess the therapeutic and the adverse effects, respectively.Results The overall response rate of the bortezomib-dexamethasone group was 90. 9% , CR 27.3% （3/ 11）, PR 36.4% （4/11）, MR 27.3% （3/11）, NC 9. 1% （1/11）, in which, the overall response rate of newly diagnosed patients was 80. 0% , CR 20. 0% （ 1/5 ） , PR 20. 0% （ 1/5 ） , MR 40. 0% （ 2/5 ） , NC 20. 0% （1/5） ; the overall response rate in relapsed/refractory patients was 100%, CR 33. 3% （2/6）, PR 50. 0% （3/6）, MR 16. 7% （1/6）. The overall response rate of the traditional chemotherapy group was 45.0%, PR 30. 0% （6/20）, MR 15.0% （3/20）, PD 10. 0% （2/20）, SD 45.0% （9/20）, in which, the overall response rate of newly diagnosed patients was 71.4% , PR 42. 6% （ 3/7 ）, MR 28. 6% （ 2/7 ）, PD14. 3% （ 1/7）, SD 14. 3% （ 1/7）, the overall response rate of relapsed/refractory patients was 50. 8%, PR 25.1% （3/15）, MR 7. 7% （ 1/13）, PD 7.7% （ 1/13）, SD 61.5% （8/13）. The X^2 test results showed that there was significant difference in overall response rate between two groups （P 〈 0. 05 ）. Compared with the traditional chemotherapy regimens, the bortezomib-dexamethasone regimen was much safer, its adverse effects were mild, including weakness, numbness of finger tips and gastrointestinal reactions, no severe hematologic and cardiac toxicity. Conclusion Bortezomib in combination with dexamethasone is a new effectire therapeutic regime

关 键 词：多发性骨髓瘤 Ⅲ期 硼替佐米 地塞米松 

分 类 号：R733.3[医药卫生—肿瘤] R730.53[医药卫生—临床医学]