以硼替佐米为主的不同化疗方案治疗多发性骨髓瘤的疗效观察

Efficacy of chemotherapy regimens based on bortezomib in the treatment of multiple myeloma

目的探讨硼替佐米+环磷酰胺+地塞米松(PCD)方案与标准或减低剂量的硼替佐米+表柔比星+地塞米松(PAD)方案治疗多发性骨髓瘤(MM)的疗效及对并发症的影响。方法选取2016年7月至2019年6月间辽宁省健康产业集团阜新矿平安医院收治的87例初治或复发难治性MM患者进行回顾性研究。按治疗方法不同进行分组,其中,采用PCD方案治疗的31例患者纳入PCD组,采用标准PAD方案治疗的27例患者纳入标准PAD组,采用低剂量PAD方案治疗的29例患者纳入低剂量PAD组。观察比较三组患者的疗效、感染及化疗不良反应。结果三组初治多发性骨髓瘤患者的深度缓解率比较,差异无统计学意义(P>0.05)。三组复发难治多发性骨髓瘤患者的深度缓解率比较,差异无统计学意义(P>0.05)。三组多发性骨髓瘤患者的总深度缓解率比较,差异无统计学意义(P>0.05)。低剂量PAD组胃肠道症状、感染及周围神经病变发生率均明显低于PCD组,PCD组的血小板减少发生率则明显低于标准PAD组及低剂量PAD组,差异均有统计学意义(均P<0.01)。结论PCD治疗与标准及低剂量PAD治疗MM的疗效相当,但低剂量PAD治疗后的感染、胃肠道反应及神经毒性等不良反应明显少于其他两种方案。

Objective To compare the efficacy of bortezomib plus cyclophosphamide and dexamethasone(PCD)and the standard or low-dose bortezomib plus epirubicin and dexamethasone(PAD)in the treatment of multiple myeloma(MM)and the effect on the complications.Methods The clinical data of87 patients with newly diagnosed or recurrent refractory MM who received treatment at Ping’an Hospital,The Fuxin Mining,Liaoning Health Industry Group from July 2016 to June 2019 were retrospectively analyzed.Of them,31 patients who received PCD were included in the PCD group,and 27 patients who received standard-dose PAD were included in the standard-dose PAD group and 29 patients who received low-dose PAD were included in the low-dose PAD group.The treatment efficacy,incidence of infection and adverse reactions were compared.Results There was no significant difference in deep remission rate among the three groups in both newly diagnosed and recurrent refractory MM patients(P>0.05).There was no significant difference in overall remission rate among the three groups(P>0.05).The incidence of gastrointestinal symptoms,infection and peripheral neuropathy was lower in low-dose PAD group than in PCD group(all P<0.05).The incidence of thrombocytopenia was lower in PCD group than in standard and low-dose PAD group.Conclusion The therapeutic effect of PCD was comparable to that of the standard and low-dose PAD,but the incidence of gastrointestinal adverse drug reactions was lower in low-dose PAD than in the other two groups.