改良VTD-PACE方案治疗多发性骨髓瘤髓外病变及浆细胞白血病的疗效分析  

Efficacy of modified VTD-PACE regimen in treatment of multiple myeloma with extramedullary disease and plasma cell leukemia

作　　者：赵薇薇 陈丽艳[1] 王连杰[1] 张蒙 李宇莹 董秀帅[1] 田垚垚[1] 王巍[1] ZHAO Wei-wei;CHEN Li-yan;WANG Lian-jie;ZHANG Meng;LI Yu-ying;DONG Xiu-shuai;TIAN Yao-yao;WANG Wei(Department of Hematology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院血液科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2021年第1期36-40,共5页Journal of Harbin Medical University

基　　金：中国博士后科学基金(2015M580270);黑龙江省博士后科学基金(LBH-Zl5129);哈尔滨医科大学附属第二医院中青年创新科学研究基金(CX2016-19)。

摘　　要：目的观察改良VTD-PACE方案(硼替佐米、来那度胺、地塞米松、顺铂、脂质体阿霉素、环磷酰胺及依托泊苷)治疗多发性骨髓瘤髓外病变(extramedullary disease,EMD)及浆细胞白血病(plasma cell leukemia,PCL)的疗效和不良反应。方法选取2017年11月~2018年9月,10例EMD或PCL患者,接受改良VTD-PACE方案治疗。记录患者的临床特征、实验室及影像学检查结果,在每个疗程结束后评估治疗效果及不良反应。结果接受治疗的患者中位疗程数4(2~6)个,总反应率(overall response rate,ORR)达80%,8例患者达到部分缓解(partial response,PR)及以上。随访时间30个月,中位总生存期(median overall survival,OS)24(5~30)个月,中位无进展生存期(progression-free survival,PFS)18(2~23)个月。主要的不良反应是周围神经病变(peripheral neuropathy,PN)、消化道症状、乏力及骨髓抑制,通过对症干预治疗耐受性良好,无治疗相关性死亡。结论改良VTD-PACE方案效率高,耐受性好,可作为治疗EMD及PCL患者的新方案。Objective To observe the efficacy and adverse effects of modified VTD-PACE regimen(bortezomib,lenalidomide,dexamethasone,cisplatin,liposome doxorubicin,cyclophosphamide,and etoposide)in treatment of multiple myeloma with extramedullary disease(EMD)and plasma cell leukemia(PCL).Methods From November 2017 to September 2018,a total of 10 diagnosed EMD or PCL patients treated with the modified VTD-PACE regimen were enrolled in our department.The clinical characteristics,laboratory and imaging findings of patients were recorded,and the therapeutic effects and adverse effects were evaluated at the end of each course.Results Patients were administered with a median course of treatment was 4(2~6),the overall response rate(ORR)was 80%,and 8 patients achieved partial response(PR)or better.The follow-up time was 30 months,median overall survival(OS)was 24(5~30)months,and median progression-free survival(PFS)was 18(2~23)months.The main adverse effects were peripheral neuropathy(PN),gastrointestinal symptoms,fatigue,and bone marrow suppression,which were well tolerated by symptomatic intervention therapy,and there were no treatment-related deaths.Conclusion The modified VTD-PACE regimen is highly effective and generally well tolerated,can be used as a new regimen for EMD and PCL patients.

关 键 词：多发性骨髓瘤 髓外病变 浆细胞白血病 来那度胺 脂质体阿霉素 

分 类 号：R733.3[医药卫生—肿瘤]