不同剂量地塞米松联合硼替佐米、表柔比星治疗多发性骨髓瘤疗效比较  

Comparison of the efficacy and safety of standard and reduced doses of dexamethasone combined with bortezomib and adriamycin in the treatment of patients with multiple myeloma

作　　者：闫志凌[1] 李振宇[1] 张焕新[1] 洪菲[1] 李护君[1] 李德鹏 邱婷婷[1] 陈伟[1] 桑威[1] 牛铭山[1] 赵恺[1] 曹江[1] 曾令宇[1] 徐开林[1] 

机构地区：[1]徐州医学院附属医院血液科,江苏徐州221002

出　　处：《徐州医学院学报》2015年第11期737-740,共4页Acta Academiae Medicinae Xuzhou

基　　金：国家自然科学基金（81300399）

摘　　要：目的探讨不同剂量地塞米松联合硼替佐米及表柔比星（PAD）方案治疗多发性骨髓瘤（MM）的疗效及安全性。方法96例初诊MM患者给予地塞米松[40mg（PADl组）或20mg（PAD2组），第1～4天静脉注射]、表柔比星（9—10mg／m2，第1～4天静脉注射）、硼替佐米（1．3mg／m2，第1、4、8、11天皮下注射）治疗，治疗4～6个疗程。观察患者的疗效和不良反应。结果PAD方案化疗4个疗程后，2组患者的总体治疗反应率、深度反应率（CR＋VGPR）差异均无统计学意义（P〉0．05）；化疗结束后随访1年，PAD1组与PAD2组1年无事件生存率（EFS）分别为56．7％、56．4％，2组差异无统计学意义（P=0．959），总生存率（OS）均为100％。白细胞、血小板减少和贫血发生率2组差异均无统计学意义（P〉0．05）；由硼替佐米诱导的周围神经炎2组间差异亦无统计学意义；PAD1组患者感染、低钾及腹胀发生率均高于PAD2组，差异有统计学意义（P〈0．01）。结论减低地塞米松剂量的PAD方案治疗初诊MM患者的疗效反应与标准剂量组类似，但患者对减低剂量PAD方案具有更好的耐受性。Objective To compare the efficacy and safety of standard or reduced doses of dexamethasone combined with bortezomib and adriamycin （PAD） in the treatment of patients with multiple myeloma （MM）. Methods A total of 96 newly diagnosed patients were intravenously injected with 40 mg （Group PAD1 ） or 20 mg（ Group PAD2） of dexamethasone and 10 mg/m2 of adriamycin on Days 1 -4, and subcutaneously injected with 1.3 mg/m2 of bortezomib on Days 1,4, 8, and 11 for four to six courses. Then, the efficacy and adverse reaction were observed. Results After four courses, no statistical difference was found in overall response rate （ORR） and very good partial response （VGPR） between both groups （ P 〉 0.05 ）. During one - year follow - up visits, the event free survival （EFS） was 56.7% and 56.4% in Groups PAD1 and PAD2, respectively （P = 0. 959）. The overall survival （OS） was 100% for each gruop. No statistical difference was seen in neutropenia, thrombocytopenia, anemia and bortezomib - induced peripheral neuropathy between the two groups （P 〉 0.05 ）. Patients in Group PAD1 presented markedly higher incidence of infection, abdominal distention and hypokalemia than those in Group PAD2 （P 〈 0.01 ）. Conclusion Compared with a standard dose, a reduced dose of PAD can produce similar clinical efficacy in initially diagnosed MM patients, with better tolerance.

关 键 词：多发性骨髓瘤 地塞米松 硼替佐米 表柔比星 

分 类 号：R452[医药卫生—治疗学]