三氧化二砷联合维生素C为主化疗方案治疗老年复发/难治性多发性骨髓瘤33例  

Major Chemotherapy Regimens of Arsenic Trioxide Combined with Vitamin C in the Treatment of 33 Cases of Elderly Patients with Relapsed/Refractory Multiple Myeloma

作　　者：曾艳[1] 韩红 严毅进 陈慧[1] 蔡文 ZENG Yan;HAN Hong;YAN Yijin;CHEN Hui;CAI Wen(Department of Hematology,Liyuan Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430077,China;The First Clinical Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院血液科,武汉430077 [2]华中科技大学第一临床学院,武汉430022

出　　处：《医药导报》2019年第10期1295-1299,共5页Herald of Medicine

摘　　要：目的探讨三氧化二砷联合维生素C为基础的化疗方案治疗老年复发难治性多发性骨髓瘤(MM)的临床疗效及安全性。方法回顾性分析2012年6月-2016年5月收治33例应用三氧化二砷联合维生素C治疗复发/难治性MM,分析患者临床资料,疗效及不良反应。结果①Durie-Salmon(DS)分期中Ⅲ期患者占72.7%,修改的国际分期系统(R-ISS)Ⅲ期患者占34.8%,47.8%患者存在高危遗传学异常。②化疗患者总体缓解率(ORR)为63.7%,其中完全缓解率(CR)为6.1%,非常好的部分缓解率(VGPR)为18.2%,部分缓解率(PR)为39.4%,15.2%患者达到微小缓解(MR),临床获益率78.9%。R-ISS分期Ⅲ期患者ORR较低。③Kaplan-Meier法分析患者中位无进展生存(PFS)时间为11个月,中位达PR时间为2个月。单因素分析中,染色体核型异常、R-ISS分期Ⅲ期具有独立预后意义。④最常见不良反应是乏力、白细胞减少、胃肠道反应等。结论三氧化二砷联合维生素C为基础的化疗方案在老年复发/难治性MM患者中有效率较高,且总体耐受性良好。预后因素分析显示,在这一患者群体中染色体核型异常、R-ISS分期Ⅲ期是独立预后不良因素。Objective To evaluate the clinical efficacy and safety of arsenic trioxide combined with vitamin C in the treatment of relapsed refractory multiple myeloma(MM) in the elderly patients. Methods The clinical data of 33 patients with recurrent/refractory MM treated with arsenic trioxide combined with vitamin C from June 2012 to May 2016 were summarized, and the therapeutic effect and adverse reactions were analyzed. Results ①72.7% of patients in Durie-Salmon(DS) stage Ⅲ, 34.8% of patients in revised international staging system(R-ISS) stage Ⅲ, and 47.8% of patients harbored at least one of the high-risk cytogenetic abnormalities.②The overall remission rate(ORR) of the chemotherapy patients was 63.7%, of which the complete remission rate(CR) was 6.1%, the very good partial remission rate(VGPR) was 18.2%, the partial remission rate(PR) was 39.4%, and the small remission rate(MR) was 15.2%.Total clinical benefit rate was 78.9%.Patients with R-ISS stage Ⅲ disease showed significantly lower ORR.③ Kaplan-Meier statistical analysis showed the median progression free survival(PFS) and the median1 duration of response(DOR) were 11 months and 2 months, respectively.Univariate prognostic analysis showed that abnormal karyotype and R-ISS stage Ⅲ were negative prognostic factors for PFS.④The most common adverse events(AEs) were weak,leukopenia, and gastrointestinal reactions. Conclusion Arsenic trioxide and vitamin C based chemotherapy regiments are effective and generally well tolerated in elderly patients with relapsed/refractory MM.Prognostic factors analysis shows that in this patient population abnormal chromosome karyotype and R-ISS stage Ⅲ are independent factors of poor prognosis.

关 键 词：三氧化二砷 维生素C 骨髓瘤 多发性 复发难治性 

分 类 号：R979.1[医药卫生—药品] R551.3[医药卫生—药学]