持续口服小剂量环磷酰胺联合泼尼松治疗复发/难治性多发性骨髓瘤伴严重心功能不全患者疗效观察  

Efficacy of continuous low-dose cyclophosphamide and prednisone regimen in refractory multiple myeloma patients with severe heart failure

作　　者：周帆[1] 韦苇[1] 凌晨晖[1] 郭列平[1] 石昊天[1] 李璐[1] 陈小玲[1] 侯健[2] 

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

出　　处：《中华血液学杂志》2015年第3期186-190,共5页Chinese Journal of Hematology

基　　金：上海市科委科研计划项目（14411973400）

摘　　要：目的 观察小剂量环磷酰胺联合泼尼松持续口服治疗复发/难治性多发性骨髓瘤（MM）伴严重心功能不全患者的临床疗效、安全性及心功能改善情况.方法 选择75例MM伴心功能不全患者,给予环磷酰胺片（50 mg/d）联合泼尼松片（15 mg/d）进行小剂量化疗.结果 75例患者中,失访2例,在可评估的73例患者中总有效率为64.4％,其中完全缓解（CR）2例（2.7％）,很好的部分缓解（VGPR）4例（5.5％）,部分缓解（PR）24例（32.9％）.中位生存时间为12（1～70）个月,中位治疗起效时间为90（16～120）d,中位无进展生存时间为12（1～60）个月.与治疗前比较,临床有效组患者血清B型脑钠肽下降[（906.4±104.8） ng/L对（336.6±30.3）ng/L,P＜0.01].患者常见的不良反应为骨髓抑制（32/73,43.8％）、感染（26/73,35.6％）和Cushing综合征（7/73,9.6％）,一般可耐受或经对症处理后可缓解.结论 小剂量环磷酰胺联合泼尼松持续口服治疗复发/难治性MM伴严重心功能不全患者可取得较好的疗效,并能改善患者心功能,具有良好的安全性.Objective To observe treatment response,survival,safety and the improvement of ECOG in patients with refractory multiple myeloma （MM） with serious heart failure after the administration of continuous low-dose of cyclophosphamide combined with prednisone （CP）.Methods From January 2005 to September 2013,a total of 75 patients were treated by metronomic chemotherapy with continuous low-dose cyclophosphamide （50 mg/d） and prednisone （15 mg/d）.Results Among the 75 patients,2 were lost for follow-up.In the 73 available patients,the overall response was 64.4%,including 2 patients （2.7%） with complete remission （CR）,4 cases （5.5%） very good partial remission （VGPR）,and 24 patients （32.9%） partial remission （PR）.The median survival was 12 months （1-70 months） with a median onset time of 90 days （16-120） and a median progressive freedom survival of 12 months （1-60）.The level of B-type natriuretic peptide in responders declined significantly,as compared to no responders [（336.6±30.3） ng/L vs （906.4± 104.8） ng/L,P〈0.01].Common adverse events were as follows：32 （43.8%） cases of bone marrow suppression,26（35.6%） cases of infection,8 cases of dizzy as well as sleepiness （11.0%）,7 （9.6%） cases of Cushing syndrome,4 （5.5%） cases of secondary diabetes mellitus,and 3 （4.1%） cases of edema respectively.Conclusion The metronomic chemotherapy of cyclophosphamide combined with prednisone had satisfactory impact on the treatment outcome,including the improvement of cardiac functions and physical capacities,better survival and safety in refractory MM with serious heart failure.It provides a novel regimen for such patients.

关 键 词：多发性骨髓瘤 抗肿瘤联合化疗方案 心力衰竭 环磷酰胺 节律性化疗 

分 类 号：R733.3[医药卫生—肿瘤]