来那度胺治疗多发性骨髓瘤的效果及对患者调节性T细胞和自然杀伤细胞水平的影响  

Efficacy of lenalidomide in treatment of multiple myeloma and its effect on levels of regulatory T cells and natural killer cells of patients

作　　者：卞建军[1] 沈磊[1] 李亮[1] 苏玉璇[1] 左金曼 孟美丽[1] 陆尧 葛书亚 傅磊 Bian Jianjun;Shen Lei;Li Liang;Su Yuxuan;Zuo Jinman;Meng Meili;Lu Yao;Ge Shuya;Fu Lei(Department of Hematology,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233040,China)

机构地区：[1]蚌埠医学院第二附属医院血液内科,蚌埠233040

出　　处：《白血病．淋巴瘤》2023年第7期400-404,共5页Journal of Leukemia & Lymphoma

基　　金：蚌埠医学院自然科学类项目(2020byzd200)。

摘　　要：目的探讨来那度胺联合硼替佐米、地塞米松(RVd)方案治疗新诊断的多发性骨髓瘤(NDMM)患者的临床效果及对调节性T细胞(Treg细胞)和自然杀伤(NK)细胞水平的影响。方法选择2019年9月至2022年5月蚌埠医学院第二附属医院收治的38例NDMM患者进行前瞻性研究,依据随机数字表法分为对照组(18例)和观察组(20例)。对照组给予硼替佐米+表柔比星+地塞米松(VAd)方案治疗,观察组给予RVd方案治疗,比较两组疗效及安全性。采用流式细胞术检测两组治疗前后Treg细胞(CD4+ CD25+ FOXP3+)及NK细胞(CD3- CD56+ CD16+)水平,并进行比较。结果 4个疗程治疗后,观察组患者客观缓解率(ORR)为95.0%(19/20),高于对照组的77.8%(14/18),差异有统计学意义(P=0.016)。治疗前,两组患者Treg细胞和NK细胞水平差异均无统计学意义(P值分别为0.381、0.650)。治疗后,对照组患者Treg细胞水平由治疗前的(1.5±0.5)%提高至(4.7±1.3)%(P=0.008),观察组患者Treg细胞水平由治疗前的(1.4±0.5)%提高至(6.8±1.5)%(P=0.001),且治疗后观察组高于对照组(P=0.027);对照组患者NK细胞水平由治疗前的(16±6)%提高至(20±5)%(P=0.004),观察组患者NK细胞水平由治疗前的(16±6)%提高至(24±6)%(P=0.006),且治疗后观察组高于对照组(P=0.032)。观察组的血小板减少和中性粒细胞减少发生率均高于对照组,差异均有统计学意义(P值分别为0.012、0.027),积极治疗后均可恢复;其他不良反应发生率差异均无统计学意义(均P>0.05)。结论 RVd方案治疗NDMM临床效果好,安全可靠,且治疗后患者Treg细胞、NK细胞水平均升高。Objective To investigate the clinical efficacy of lenalidomide combined with bortezomib and dexamethasone(RVd)regimen in treatment of newly diagnosed multiple myeloma(NDMM)patients and its effect on the levels of regulatory T cells(Treg cells)and natural killer(NK)cells.Methods Thirty-eight NDMM patients who were admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2019 to May 2022 were selected for a prospective study,and were divided into control group(18 cases)and observation group(20 cases)according to random number table method.The control group was treated with bortezomib+epirubicin+dexamethasone(VAd)regimen,and the observation group was treated with RVd regimen.The efficacy and safety were compared between the two groups.The levels of Treg cells(CD4+CD25+FOXP3+)and NK cells(CD3-CD56+CD16+)before and after treatment in the two groups were detected by flow cytometry,and the results were compared.Results After 4 courses of treatment,the objective response rate(ORR)of the observation group was 95.0%(19/20),which was higher than that of the control group[77.8%(14/18)],and the difference was statistically significant(P=0.016).Before treatment,there was no statistical difference in the levels of Treg cells and NK cells between the two groups(P values were 0.381 and 0.650).After treatment,the level of Treg cells in the control group increased from(1.5±0.5)%before treatment to(4.7±1.3)%(P=0.008),while the level of Treg cells in the observation group increased from(1.4±0.5)%before treatment to(6.8±1.5)%(P=0.001),and the level in the observation group was higher than that in the control group(P=0.027);the level of NK cells in the control group increased from(16±6)%before treatment to(20±5)%(P=0.004),while the level of NK cells in the observation group increased from(16±6)%before treatment to(24±6)%(P=0.006),and the level in the observation group was higher than that in the control group(P=0.032).The incidence rates of thrombocytopenia and neutropenia in the observation group wer

关 键 词：多发性骨髓瘤 T淋巴细胞 调节性 杀伤细胞 天然 来那度胺 

分 类 号：R733.3[医药卫生—肿瘤]