硼替佐米联合地塞米松治疗多发性骨髓瘤疗效及影响因素分析  

Clinical experience and prognostic factors with bortezomib combined regimen in 40 patients with multiple myeloma

作　　者：赵莹[1] 李娟[1] 曾丽金[1] 丁艳[1] 王荷花[1] 郑冬[1] 童秀珍[1] 张国材[1] 

机构地区：[1]中山大学附属第一医院血液科,广州510080

出　　处：《中国实用内科杂志》2009年第6期526-528,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察硼替佐米联合地塞米松治疗多发性骨髓瘤患者的疗效、与疗效有关的预后因素及化疗毒副反应。方法2006年5月至2008年7月中山大学附属第一医院40例初治、难治和(或)复发MM患者接受硼替佐米联合地塞米松(VD)方案治疗,每3周为1个疗程。结果总反应率75.0%(30/40),完全缓解(CR)+接近完全缓解(nCR)率42.5%(17/40),80.0%(24/30)患者在1个疗程后即可看到疗效,中位达最佳疗效时间为2个疗程。与非轻链患者相比,轻链型患者总反应率(100.0%对65.5%,P=0.038)和CR率(36.4%对6.9%,P=0.039)均明显高于前者,而且起效更快,81.8%(9/11)的患者在1个疗程后即达最佳疗效。VD方案Ⅲ～Ⅳ级不良反应发生率低,包括白细胞减少、血小板减少、腹泻和乏力,经对症治疗或推迟化疗后均可恢复。感染发生率高(35.0%),是重要的死亡原因之一。结论硼替佐米联合地塞米松治疗MM患者有明显疗效,在轻链型患者疗效更加显著,起效更快,副反应可以耐受。Objective To explore the medical effects,prognostic factors relating to the effects and side effects of bortezomib combined regimen in treatment of muhiple myeloma（MM）. Methods From May 2006 to July 2008 in the First Affiliated Hospital of Su Yat-sen University. Forty newly diagnosed and relapsed or refractory MM treated with the regimen of combination of bortezomih and dexamethasone in a cycle of 3 weeks. Results Total response rate was 75.0% （30/40） , and the rate of CR ＋ nCR was 42.5% （17/40）. Eighty percent patients（24/30） showed effects after the first cycle,although the median time of best effect was 2 cycles. Compared to the other types,light-chain type had higher total response rate（ 100.0% vs 65.5% , P = 0. 038 ） and CR rate （ 36.4% vs 6. 9% , P = 0. 039 ） , and also responded earlier with 81.8% （9/11 ）patients reaching the best effect after the first cvcle. Grade Ⅲ-Ⅳ adverse effects in this VD regimen was low,including leucocytopenia, thrombocytopenia, diarrhea and debility, and could be relieved by symptomatic treatment or delaying the chemotherapy. The rate of infection was high and which was one of the important cause of death. Conclusion The Bortezomib combined regimen has significant effect in MM treatment,especially in light chain type patients, with earlier effect onset. This regimen can he tolerant in most patients.

关 键 词：多发性骨髓瘤 硼替佐米 地塞米松 预后因素 

分 类 号：R5[医药卫生—内科学]