硼替佐米为主的联合方案治疗初治多发性骨髓瘤

Bortezomib-based combination therapy for newly diagnosed multiple myeloma

目的回顾性比较分析硼替佐米为主方案（VD／VT）与长春新碱联合阿霉素和地塞米松（VAD）方案治疗初治多发性骨髓瘤（MM）的疗效及不良反应。方法18例初治MM患者采用硼替佐米1．0mg／m^2或1．3mg／m^2，1、4、8、11d给药；12例联合地塞米松20～40nag，1～4d；6例联合沙立度胺100mg／d，21d为一疗程。24例MM患者采用VAD方案。结果硼替佐米组总反应率88．9％（16／18），完全缓解或接近完全缓解率38．9％（7／18），显著优于VAD组，分别为41．7％，4．2％。硼替佐米组主要的不良反应依次为血液系统毒性，胃肠道反应和周围神经病变。VAD组主要不良反应为感染、脱发及静脉炎。结论硼替佐米为主的联合化疗在初治MM中疗效显著优于VAD组，尤其在高危人群如严重骨质破坏、肾功能不全及不良染色体表现的患者，缓解率高，毒副作用轻，应优先考虑使用。

Objective To study retrospectively the response and side effects in two groups of patients with untreated multiple myeloma receiving bortezomib-based regimen （VD/VT） and vincristine combined with adriamycin and dexamethasone （VAD）. Methods Eighteen patients were enrolled in a group of VD or VT, receving bortezomib 1.0 mg/m^2 or 1.3 mg/m^2 on days 1,4,8 and 11, along with dexamethasone 20-40 mg on days 1-4 （12 cases ）;or thalidomide 100 mg/d continuously （6 cases ）. Twenty-four patients treated with VAD entered into a control group, receiving vincristine 0. 4 mg/d on days 1- 4,adriamycin 9 mg · m^-2 · d^-1 on days 1-4 and dexamethasone on days 1-4,9-12,17-20,with 28 days as a cycle. Results After bortezomib-based combinations, 16 of with 18 patients （ 88.9% ） achieved at least a partial response, including complete response and near complete response in 7 patients （38. 9% ）. Side effects in the VD/VT group were predictable and manageable; they were mainly haematologic, gastrointestinal, and peripheral neuropathic and were more evident during early cycles. The main side reactions in the VAD group were infections, loss of hair and phlebitis. Conclusion Bortezomib-based combinations therapy is an effective and safe induction regimen for newly diagnosed multipli myeloma patients and appears significantly superior to VAD,yielding high response rates even in patients with poor prognostic features.