硼替佐米再治疗多发性骨髓瘤76例疗效及安全性分析  

The efficacy and safety analysis of bortezomib retreatment in 76 patients with relapsed/refractory multiple myeloma

作　　者：卢静[1] 侯健[1] 张春阳[1] 袁振刚[1] 蓝海峰[1] 周帆 樊建玲[1] 周莉莉[1] 杜鹃[1] 姜华[1] 金丽娜[1] 曾添美[1] 傅卫军[1] 

机构地区：[1]第二军医大学长征医院血液科、全军骨髓瘤与淋巴瘤疾病中心,上海200003 [2]上海市闸北中心医院血液科

出　　处：《中华血液学杂志》2013年第4期309-312,共4页Chinese Journal of Hematology

摘　　要：目的探讨硼替佐米再治疗多发性骨髓瘤（MM）的疗效及安全性。方法回顾性分析2006年5月至2011年8月收治的76例硼替佐米初次治疗疗效达部分反应（PR）以上，复发或疾病进展后予以硼替佐米再治疗的MM患者，评价硼替佐米再治疗的疗效及不良反应。结果硼替佐米再治疗MM的总有效率（ORR）为60．5％，其中完全反应（CR）率6．5％，非常好的部分反应（VGPR）率15．8％，PR率38．2％。按硼替佐米初治后疗效分为CR、VGPR、PR组，3组患者再治疗后ORR分别为84．6％、73．1％和43．2％。按患者硼替佐米再治疗后疗效分成2组，达到PR及以上的为有效组，未达到PR的为无效组，两组自硼替佐米再治疗后中位疾病无进展生存期分别为7（1～39）个月和5（1—14）个月（P〉0．05）；中位总生存期分别为16（2—64）个月和8（1—28）个月（P〈0．05）。88．2％的患者硼替佐米再治疗时出现不同程度的不良反应，其中仅9．2％（7例）患者为Ⅲ～Ⅳ级，主要为中性粒细胞减少、腹泻和血小板减少，仅1例发生严重的周围神经病变。结论硼替佐米初治疗效好的MM患者，再予以硼替佐米治疗反应率高，不良反应发生率较前无明显增加。Objective To evaluate the efficacy and safety of bortezomib retreatment in 76 patients with relapsed/refractory multiple myeloma （MM）, who previously responded to bortezomib. Methods Retrospective analysis of 76 MM patients, who had achieved at least a partial response （PR） on initial bortezomib therapy in our hospital from May 2006 to August 2011, received bortezomib retreatment when they relapsed or progressed. Results The overall response rate （ORR） was 60.5% , among them 6.5% patients achieved CR, 5.8% patients achieved very good partial response （VGPR）, 38.2% patients achieved PR. Then we further stratified all patients into 3 groups according to the response of initial bortezomib therapy, ineluding CR group, VGPR group and PR group. After bortezomib retreatment, the ORR of the 3 groups was 84.6% , 73.1% and 43.2%, respectively. According to the response of bortezomib retreatment, the patients were divided into 2 groups： group 1 who at least achieved PR, group 2 who showed no response. The median progression-free survival （PFS） after bortezomib retreatment for group 1 and 2 was 7（ 1 -39） and 5（ 1 - 14） months, respectively （ P 〉 0.05 ）, while the median overall survival （OS） after bortezomib retreatment was 16（2 -64） and 8（ 1 -28） months, respectively （P 〈0.05）. Adverse events （AE） were identified in 88% patients during bortezomib retreatment, including neutropenia, diarrhea and thromboeytopenia, only 9.2% （7 patients） reached m - rv grade of AE. Severe peripheral neuropathy occurred in only one patient. Conclusion Bortezomib retreatment regimen is demonstrated a higher response rate in patients who achieved deeper response in initial treatment, with no more adverse events.

关 键 词：硼替佐米 多发性骨髓瘤 治疗结果 

分 类 号：R733[医药卫生—肿瘤]