硼替佐米和沙利度胺为主的化疗方案对伴有肾功能不全的多发性骨髓瘤患者的疗效比较  

Comparison of the clinical efficacy of bortezomib and thalidomide-based chemotherapy for multiple myeloma patients with renal insufficiency

作　　者：张忆梓[1] 侯健[1] 周帆[2] 郭列平[1] 闫岩[2] 石昊天[1] 韦苇[1] 凌晨晖[1] 李璐[1] 

机构地区：[1]上海市闸北区中心医院血液科,上海200070 [2]第二军医大学附属长征医院血液科

出　　处：《临床血液学杂志》2011年第4期404-407,共4页Journal of Clinical Hematology

摘　　要：目的:观察以硼替佐米为主和沙利度胺为主的化疗方案治疗伴有肾功能不全的多发性骨髓瘤(MM)患者的疗效,探讨对伴有肾功能不全的MM治疗的最佳方案。方法:40例伴有肾功能不全的MM患者,其中初治20例,复发(难治)20例。选择20例使用以硼替佐米为主的化疗方案作为试验组,以同期20例接受沙利度胺为基础的联合化疗方案治疗的MM患者作对照。结果:可评估的40例患者,中位随访时间16(1～64)个月,在相同的肾脏基础损伤水平的情况下,硼替佐米组患者内生肌酐清除率治疗后较治疗前有明显改善,P<0.05。与同期沙利度胺组比较P<0.01,提示硼替佐米治疗肾功能不全的MM患者疗效优于沙利度胺组。硼替佐米组2个疗程时完全缓解(CR)1例,接近完全缓解(nCR)3例,部分缓解(PR)6例,对照组nCR 1例,PR 3例(P<0.05)。2个疗程后,硼替佐米组共有11例肌酐降至正常范围,沙利度胺组仅5例。半年复发率2组比较差异有统计学意义,治疗组20例中半年无一例复发,对照组20例中半年有5例复发(P<0.05)。结论:以硼替佐米为主的化疗方案治疗伴有肾功能不全的MM患者的疗效优于以沙利度胺为基础的联合方案,而且起效较快。Objective：To compare the clinical efficacy of bortezomib-based chemotherapy and thalidomide-based chemotherapy for multiple myeloma（MM） patients accompanied with renal insufficiency,and to explore the best treatment.Method：Among 40 cases of MM patients accompanied with renal insufficiency,Twenty cases were at initial treatment and other 20 cases were relapsed（refractory）.Twenty cases who receied bortezomib-based chemotherapy were selected as the pilot group.Other 20 patients who received thalidomide-based combination chemotherapy were selected as the control group.Result： The median follow-up period was 16（1-64） months.At the same level of renal basal injury,the endogenous creatinine clearance rate in bortezomib group were significantly improved after treatment（P0.05）.The clinical efficacy of bortezomi based treatment on MM with renal dysfunction was significantly greater than that of thalidomide based treatment（P0.01）.After two treatment courses,the patients in bortezomib group gained 1 CR,2 nCR and 5 PR,wihle the patients in control group only gained 1 nCR and 2 PR（P0.05）.After 2 courses,the creatinine levels returned to normal in 11 cases of bortezomib group,but only in 5 cases of thalidomide group.The relapse rate following six months was significantly different between bortezomib group and control group（0 case versus 5 cases,P0.05）.Conclusion：Bortezomib-based chemotherapy is superior to thalidomide-based chemotherapy in the treatment of MM patients with renal failure.

关 键 词：多发性骨髓瘤 肾功能不全 硼替佐米 治疗结果 

分 类 号：R733.3[医药卫生—肿瘤]