采用硼替佐米为主的联合化疗方案治疗多发性骨髓瘤42例  

Bortezomib-based Combination Chemotherapy in Treatment of 42 Patients with Multiple Myeloma

作　　者：郭晓[1] 侯兰芬[1] 李文静[1] 王友君[1] 王志伟[1] 郭宏谋[1] 孙宇[1] 

机构地区：[1]解放军白求恩国际和平医院血液科,石家庄050082

出　　处：《解放军医药杂志》2014年第8期85-88,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的：观察硼替佐米为主的化疗方案治疗多发性骨髓瘤（ MM）的效果和安全性。方法选择解放军白求恩国际和平医院血液科2010年3月-2013年6月收治的42例MM,其中初发24例,复发难治18例。采用硼替佐米为主的化疗方案（硼替佐米＋沙利度胺＋地塞米松＋表柔比星）治疗,总结疗效,比较治疗前后骨髓内MM细胞百分比及血清M蛋白、β2-微球蛋白变化,观察毒性反应的发生情况。结果本组24例初治MM完全缓解（ CR）率为25%,总有效率为87.5%；18例复发难治MM CR率为16.7%,总有效率为49.8%。治疗后患者骨髓内MM细胞百分比及血清M蛋白、β2-微球蛋白水平较治疗前均有明显下降（ P〈0.01）。27例出现四肢麻木、疼痛,3例出现胸部胀痛,18例出现不同程度的恶心、腹胀、便秘、呕吐、头晕,15例出现血小板下降1~2级,3例出现全血细胞减少,6例出现红色斑丘疹,3例出现带状疱疹,上述患者经对症治疗或延长用药间隔均好转；1例发生肺栓塞,经抢救无效死亡；2例发生脑梗死,经专科治疗后逐渐恢复。结论硼替佐米为主的联合化疗方案对MM尤其是初发患者效果较好,患者总体耐受性可,毒性反应以周围神经病变为主,治疗中要高度重视并积极预防栓塞。Objective To observe the efficacy and safety of Bortezomib-based combination chemotherapy in treatment of multiple myeloma （ MM） . Methods A total of 42 patients with MM during March 2010 and June 2013 were selected, including 24 primary patients and 18 relapsed or refractory patients. All the patients underwent Bortezomib-based combination chemotherapy （ Bortezomib ＋ Thalidomide ＋ Dexamethasone ＋ Epirubicin） , and curative effect was summarized. The percentages of MM cells within the bone marrow and changes of serum M protein andβ2-microglobulin before and after treatment were compared, and incidence rate of toxic reaction was also observed. Results Of the 24 pri-mary MM patients, the complete remission （CR） rate was 25%, and total effective rate was 87. 5%;of 18 relapsed or refractory patients, the CR rate was 16. 7%, and total effective rate was 49. 8%, The percentage of MM cells within the bone marrow and levels of serum M protein and β2- microglobulin after treatment were significantly reduced, compared with those before treatment （P〈0. 01）. Among 42 patients, 27 patients suffered limbs anesthesia and pains;3 patients had chest gas pains;18 patients suffered different degrees of nausea, abdominal distension, constipation, vomiting and dizziness;15 patients had grade 1-2 thrombocytopenia;3 patients had pancytopenia;6 patients had red maculopapular rash;3 patients had shingles. All the symptoms were relieved after symptomatic treatment or lengthened medication dura-tion;1 patient died of pulmonary embolism, 2 patients with cerebral infarction gradually recovered after specific treat-ment. Conclusion The Bortezomib-based combination chemotherapy may achieve good effect and common tolerance in treatment of primary patients, and the main toxic reactions are peripheral neuropathy, so clinicians should pay more atten-tion to preventing embolism complications.

关 键 词：硼替佐米 多发性骨髓瘤 抗肿瘤联合化疗方案 治疗结果 药物不良反应 

分 类 号：R979.1[医药卫生—药品] R733.3[医药卫生—药学]