BD方案与VAD方案治疗多发性骨髓瘤的疗效比较  

Comparative Study of the Curative Effects of BD Regimen and VAD Regimen in the Treatment of Multiple Myeloma

作　　者：肖萌[1] 何娟[1] 李艳[1] 苏楠[1] 徐赢东[1] 王玉婷[2] 王庆玲[1] 李树国[3] 

机构地区：[1]中国医科大学附属第一医院血液科,沈阳110001 [2]中国医科大学附属第一医院输血科,沈阳110001 [3]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中国医科大学学报》2011年第4期352-356,共5页Journal of China Medical University

摘　　要：目的比较硼替佐米联合地塞米松方案(BD方案)与VAD方案治疗多发性骨髓瘤的临床疗效及安全性。方法回顾性分析120例多发性骨髓瘤病例,根据其治疗方案分为:(1)BD组(n=37):其中初治16例,复发/难治21例;(2)VAD组(n=83):其中初治39例,复发/难治44例。化疗4～7个疗程后全面评价两组疗效及副反应。采用EBMT/ABMT标准判定疗效,并按WHO标准判断不良反应。结果 (1)BD组:中位生存期为43.5个月,2年和4年生存率分别为86.4%和47.3%,平均起效疗程数为2.06,总有效率为91.9%,其中CR/nCR32.4%(12/37),PR48.6%(18/37),MR10.8%(4/37)。初治患者CR/nCR37.5%(6/16),PR50.0%(8/16),MR6.3%(1/16),NR6.3%(1/16),有效率为93.8%;复发/难治患者CR/nCR28.6%(6/21),PR47.6%(10/21),MR14.3%(3/21),NR4.8%(1/21),PD4.8%(1/21),有效率为90.5%;(2)VAD组:中位生存期为29.1个月,2年和4年生存率分别为64.3%和33.5%,平均起效疗程数为3.09,总有效率为66.3%,其中CR/nCR12.0%(10/83),PR38.6%(32/83),MR15.7%(13/83)。初治患者CR/nCR15.4%(6/39),PR38.5%(15/39),MR12.8%(5/39),NR20.5%(8/39),PD12.8%(5/39),有效率66.7%;复发/难治患者CR/nCR9.1%(4/44),PR38.6%(17/44),MR18.2%(8/44),NR18.2%(8/44),PD15.7%(7/44),有效率为65.9%。χ2检验结果显示,2组方案疗效之间比较差异有统计学意义(P<0.05);经Log-rank检验发现,2组生存率比较差异有统计学意义(P<0.05);(3)与VAD组相比,BD组不良反应较轻微,患者耐受性较好。结论与VAD方案相比,BD方案能达到更高的缓解率,显著延长患者的生存期,并提高患者的生活质量,疗效显著,毒副反应小,耐受性好。Objective To compare the efficacy and safety between bortezomib in combination with dexamethasone regimen（BD regimen） and VAD regimen in treatment of multiple myeloma.Methods Totally 120 patients with multiple myeloma were analysed retrospectively and were divided into two groups according to their treatment protocols：BD group（37 cases）,of which 16 were newly diagnosed and 21 were relapsed/refractory;VAD group（83 cases）,of which 39 were newly diagnosed and 44 were relapsed/refractory.The effectiveness and toxicity of the two regimens were evaluated comprehensively after 4 to 7 courses of chemotherapy.EBMT and WHO criterias were used to assess the therapeutic and the adverse effects,respectively.Results The median survival time,2-and 4-year overall survival rates and the average response courses of the BD group were 43.5 months,86.4% and 47.3%,and 2.06,respectively and the overall response rate was 91.9%[CR/nCR 32.4%（12/37）,PR 48.6%（18/37）,MR 10.8%（4/37）].In BD group,the overall response rate of newly diagnosed patients was 93.8% [CR/nCR 37.5%（6/16）,PR 50.0%（8/16）,MR 6.3%（1/16）,NR 6.3%（1/16）];the overall response rate in relapsed/refractory patients was 90.5%[CR/nCR 28.6%（6/21）,PR 47.6%（10/21）,MR 14.3%（3/21）,NR 4.8%（1/21）,PD 4.8%（1/21）].The median survival time,2-and 4-year overall survival rates and the average response courses of VAD group were 29.1 months,64.3% and 33.5%,and 3.09,respectively and the overall response rate was 66.3%[CR/nCR 12.0%（10/83）,PR 38.6%（32/83）,MR 15.7%（13/83）].In VAD group,the overall response rate of newly diagnosed patients was 66.7%[CR/nCR 15.4%（6/39）,PR 38.5%（15/39）,MR 12.8%（5/39）,NR 20.5%（8/39）,PD 12.8%（5/39）];the overall response rate in relapsed/refractory patients was 65.9%[CR/nCR 9.1%（4/44）,PR 38.6%（17/44）,MR 18.2%（8/44）,NR 18.2%（8/44）,PD 15.7%（7/44）].χ2 test and the Log-rank test showed that there was significant difference in overall response rate and survival rat

关 键 词：硼替佐米 BD方案 VAD方案 多发性骨髓瘤 

分 类 号：R733.3[医药卫生—肿瘤]