来那度胺治疗复发或难治性多发性骨髓瘤患者的临床观察  

Clinical observations of lenalidomide combination chemotherapy for relapsing or refractory multiple myeloma

作　　者：李新[1] 孙万军 安娜[1] 黄仲夏[1] 陈世伦[1] 申曼[1] 钟玉萍[1] 张佳佳[1] 胡影[1] 詹晓凯[1] 

机构地区：[1]北京首都医科大学附属北京朝阳医院京西院区血液科北京市多发性骨髓瘤医疗研究中心,100043 [2]北京第二炮兵总医院血液科

出　　处：《中华医学杂志》2015年第10期745-748,共4页National Medical Journal of China

摘　　要：目的 探讨来那度胺治疗复发或难治性多发性骨髓瘤（MM）患者的疗效及不良反应.方法 回顾性分析了2013年6月至2014年10月北京朝阳医院西院收治的14例复发或难治性MM患者,采用以来那度胺为主的治疗方案,来那度胺口服治疗剂量为25 mg,每日或隔日口服21 d,休息7d.其中应用RD方案（联合地塞米松）治疗6例,RCD方案（联合异环磷酰胺和地塞米松）治疗4例,RDD方案（联合脂质体阿霉素和地塞米松）治疗1例,PRD方案（联合硼替佐米和地塞米松）1例,R＋ DECP方案（联合顺铂、依托泊苷、异环磷酰胺、泼尼松）2例.结果 14例患者中2例患者未完成1个周期的治疗而死亡,10例患者完成了以来那度胺为主的化疗2个疗程,其中2例达到接近完全缓解/完全缓解（nCR/CR）,6例部分缓解（PR）,2例疾病稳定（SD）,总有效率（ORR=CR＋PR）为8/10.10例患者完成了3个周期,其中3例CR,5例PR,2例SD.9例患者完成了4个周期的治疗,3例CR,5例PR,1例疾病进展（PD）.6例患者完成了5个周期化疗,其中1例CR,3例PR,2例PD.3例患者完成了6个周期的化疗,1例CR,1例PR,1例PD.乏力、食欲不振、血象下降是最为常见的症状.6例患者死亡.结论 来那度胺联合化疗治疗复发或难治性MM疗效较高、耐受性良好,可作为复发或难治MM患者有效的治疗选择之一.Objective To explore the clinical efficacies and toxicities of lenalidomide combination chemotherapy in the treatment of relapsing or refractory multiple myeloma （MM） patients.Methods A total of 14 MM patients were recruited to receive lenalidomide combination chemotherapy in Beijing Chaoyang hospital from June 2013 to October 2014.Lenalidomide 25 mg was taken orally daily or every alternate day for 21 days and resting for 7 days.The regimens were RD （lenalidomide and dexamethasone,n =6）,RCD （lenalidomide,ifosfamide and dexamethasone,n =4）,RDD （lenalidomide,liposomal doxorubicinand dexamethasone,n =1）,PRD （lenalidomide,velcade and dexamethasone,n =1） and R ＋ DECP （lenalidomide,cisplatin,etoposide,ifosfamide and dexamethasone,n =2）.Results Among them,two patients died during the first cycle of lenalidomide.Ten patients finished 2 cycles of treatment and 2 patients attained near complete remission or complete remission （nCR/CR）,6 partial remission （PR） and 2 stable disease （SD） with an overall response rate （ORR） of 8/10.Ten patients finished 3 cycles of treatment and 3 attained CR,5 PR and 2 SD.Nine patients finished 4 cycles of treatment and 3 attained CR,5 PR and 1 progressive disease （PD）.Six patients finished 5 cycles of treatment and 1 attained CR,3 PR and 2 PD.Three patients finished 6 cycles of treatment and 1 attained CR,1 PR and 1 PD.And the most common adverse reactions were fatigue,loss of appetite and hypocytosis.Six patients died.Conclusion The lenalidomide combination chemotherapy is both efficacious and safe in the treatment of relapsing or refractory MM.

关 键 词：多发性骨髓瘤 临床方案 复发或难治 来那度胺 

分 类 号：R733.3[医药卫生—肿瘤]