硼替佐米联合地塞米松治疗多发性骨髓瘤临床研究  

Bortezomib combined with dexamethasone in treatment of multiple myeloma:a clinical study

作　　者：陆敏秋[1,2] 吴梦青[1,2] 白砚霞[1,2] 左杏果[1,2] 褚彬[1,2] 石磊[1,2] 刘蕾[1,2] 

机构地区：[1]北京积水潭医院血液科 [2]北京大学第四临床医学院,北京100035

出　　处：《中国实用内科杂志》2011年第9期713-715,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(PD)在多发性骨髓瘤(MM)中的应用。方法 2008年2月至2010年4月北京积水潭医院36例MM患者接受PD治疗。以同期46例VADT化疗的MM患者做为对照。分析病情转归及不良反应。结果 (1)PD用于初治和复发和(或)难治MM患者疗效均显著。初治组治疗有效率85.7%(18/21);复发和(或)难治组的有效率为80.0%(12/15);总有效率为83.3%(30/36)。PD与VADT治疗初治MM的有效率差异无统计学意义(85.7%对78.1%,P=0.740),PD治疗复发和(或)难治MM的有效率明显高于VADT组(80.0%对42.9%,P=0.039)。PD起效快,治疗有效的患者均在1个疗程后达PR;63.9%患者在3个疗程内达到VGPR以上缓解,优于VADT组的30.4%。(2)PD不良反应主要有乏力、周围神经病变及血小板减少等。PD治疗初治MM较复发和(或)难治MM不良反应小,耐受性好,更能坚持长期化疗以获得最大缓解。(3)PD治疗的MM患者骨痛缓解快,全身骨密度增高较VADT组更显著[(1.138±0.102)g/cm2对(1.053±0.137)g/cm2,P=0.039)]。结论硼替佐米联合地塞米松治疗MM缓解率高,可首选用于治疗初治及复发和(或)难治MM。Objective To observe the use of bortezomib plus dexamethasone （PD） in treatment of multiple myeloma （MM）. Methods Between February 2008 and April 2010,thirty-six MM patients underwent PD treat- ment in Beijing Jishuitan Hospital. A contemporary cohort of 46 MM patients receiving VADT chemotherapy was set as the control group. The prognosis of disease and adverse effects were analyzed. Results （ 1 ） PD treatment showed significant efficacy in both newly diagnosed and relapsed/refractory patients. The rate of response was 85.7% （ 18/21 ） in newly diagnosed group and 80. 0% （ 12/15 ） in relapsed/refractory group,with the rate of o- verall response being 83.3% （30/36）. The rate of response did not differ between PD and VADT treatments for newly diagnosed MM patients （85.7% vs 78.1% ,P =0. 740） but was higher with PD treatment than with VADT treatment among relapsed/refractory MM patients （ 80. 0% vs 42. 9% , P = 0. 039 ）. The PD treatment appeared fast-acting, yielding partial remission （PR） in only one treatment course for all responders, and very good partial resmission （VGPR） or above in no more than 3 courses in 63.9% of patients compared with 30. 4% of those on VADT. （2） The adverse effects of PD were mainly fatigue, peripheral neuropathy and thrombocytopenia. Newly diagnosed patients on PD treatment showed less adverse effects, good tolerance and better compliance to long-term chemotherapy that would favor maximal remission as compared with relapsed/refractory cases. （3）Patients on PD treatment had a rapid remission in bone pain and significantly increased bone density than those on VADT treatment[ （1. 138 ± 0. 102）g/cm2 vs （1. 053 ± 0. 137 ）g/cm2, P = 0. 039 ]. Conclusion PD treatment is associated with higher rate of remission in treatment of MM, and therefore can be used as a first-line option for treatment among newly diagnosed and relapsed/refractory patients.

关 键 词：多发性骨髓瘤 硼替佐米 疗效 不良反应 

分 类 号：R551.3[医药卫生—血液循环系统疾病]