异环磷酰胺联合脂质体多柔比星、地塞米松方案治疗复发／难治多发性骨髓瘤临床观察  

Effects of ifosfamide in combination with pegylated liposomal doxorubicin and dexamethasone in the treatment of relapsed/refractory multiple myeloma

作　　者：安娜[1] 申曼[1] 李新[1] 黄仲夏[1] 陈世伦[1] 

机构地区：[1]首都医科大学附属北京朝阳医院西院血液肿瘤科,100043

出　　处：《中华医学杂志》2016年第44期3573-3576,共4页National Medical Journal of China

基　　金：北京市科技计划（Z161100000516231）

摘　　要：目的观察应用异环磷酰胺联合脂质体多柔比星、地塞米松（CDD）方案治疗复发／难治多发性骨髓瘤（MM）患者的临床疗效和不良反应。方法回顾性分析2012年1t月至2015年11月北京朝阳医院京西院区血液科应用CDD方案治疗的30例复发／难治MM患者临床资料。CDD方案为：异环磷酰胺0．5～1．0g／d，化疗第1—4天（d1～4）；脂质体多柔比星40～60mg／d，d1；地塞米松10～20mg／d，d1～4。每21天或28天为1个疗程，每2个疗程评价疗效。结果（1）治疗总有效率（ORR）为50．O％，完全缓解（CR）＋接近完全缓解（nCR）率为10．0％。（2）无髓外浆细胞瘤（EMP）的23例患者ORR为43．5％，CR＋nCR率为8．7％；有EMP的7例患者ORR为5／7，CR＋nCR率为1／7。两组患者的ORR和CR＋nCR率比较，差异无统计学意义（P〉0．05）。（3）除5例疗效评价为疾病进展的患者外，其余25例患者中位无进展生存（PFS）期为8．0个月（3．0—25．0个月）。无EMP的患者中位PFS期为8．5个月（3．0—25．0个月），有EMP的患者中位PFS期为6．0个月（2．0～21．0个月），两者相比差异无统计学意义（P〉0．05）。不良反应包括便秘、感染、血糖升高、血细胞减少等，经对症处理好转，不影响后续治疗。结论CDD方案可用于复发／难治MM的治疗，特别是有EMP的患者，疗效较好，药物耐受性较好。Objective To investigate the efficacy and adverse effects of ifosfamide in combination with pegylated liposomal doxorubicin and dexamethasone （CDD） in treating patients with relapsed/refractory multiple myeloma （MM）. Methods The clinical data of 30 relapsed/refractory MM patients treated with CDD regimen in Department of Hematology and Oneology of Beijing Chaoyang Hospital from November 2012 to November 2015 were retrospectively analyzed. The CDD treatment included ifosfamide 0. 5 - 1.0 g/d on d1-4, pegylated liposomal doxorubicin 40 -60 mg/d on dl, and dexamethasone 10 -20 mg/d on d1 -4. One cycle consisted of 21 or 28 days. Efficacy analysis was performed after every two cycles. Results （ 1 ） The overall response rate （ORR） was 50. 0% and the complete remission and near complete remission （CR ＋ nCR） rate was 10. 0%. （2）The ORR of the 23 patients without extramedullary plasmacytoma（EMP） was 43.5% and the CR ＋ nCR rate was 8.7%. The ORR of the 7 patients with EMP was 5/7 and the CR ＋ nCR rate was 1/7. There were no statistically significant differences in ORR and CR ＋ nCR rate between the two groups （ both P 〉 0.05 ）. （ 3 ） Except for the 5 patients with disease progression, the median progression- free survival （PFS） of the other 25 patients was 8.0 （ 3.0 - 25.0） months. The median PFS of the patients without EMP was 8. 5 （3.0 -25. 0） months, that of the patients with EMP was 6. 0 （2. 0 -21.0） months, with no statistically significant difference （P 〉 0. 05 ）. The adverse effects included constipation, infection, hyperglycemia, and hemocytopenia, which were controlled by symptomatic treatment and did not affect the chemotherapy. Conclusion CDD regimen can be used for the treatment of relapsed/refractory MM, especially in patients with EMP, with good efficacy and tolerance.

关 键 词：多发性骨髓瘤 复发 髓外浆细胞瘤 脂质体多柔比星 不良反应 

分 类 号：R733.3[医药卫生—肿瘤]