硼替佐米联合环磷酰胺和地塞米松治疗多发性骨髓瘤28例临床观察

Effects of bortezomib in combination with dexamethasone and cyclophosphamide for the treatment of multiple myeloma

目的:观察硼替佐米联合环磷酰胺和地塞米松治疗多发性骨髓瘤的临床疗效和药物不良反应。方法:对28例初发和复发难治性多发性骨髓瘤用硼替佐米1.0～1.3mg/m2,每疗程的第1、4、8、11天静脉注射;环磷酰胺0.3g/m2,每疗程的第1、4、8、11天静脉注射;地塞米松40mg/d,每疗程的第1～2天、第4～5天、第8～9天及第11～12天静脉滴注,每28d为1个疗程,接受4个疗程的治疗,同时在每个疗程的开始进行骨髓细胞学、血M蛋白、β2-微球蛋白(β2-MG)进行检测,并观察药物的不良反应。结果:①28例患者都有效,有效率为100%,其中完全缓解(CR)8例,CR率为28%,接近完全缓解(nCR)2例,部分缓解(PR)13例,轻微反应(MR)5例。②骨髓瘤细胞百分比、M蛋白含量、β2-MG含量在化疗前后均差异有统计学意义(均P<0.05)。③不良反应以胃肠道反应最为常见,同时也可出现血小板减少,带状疱疹,周围神经病变等。结论:硼替佐米联合环磷酰胺和地塞米松对初发和复发难治性多发性骨髓瘤有明显的临床疗效,且药物不良反应较轻,耐受性良好。

Objective：To investigate the efficacy and toxicity of bortezomib in combination with dexamethasone and cyclophosphamide for the treatment of multiple myeloma.Method：Twenty-eight patients with multiple myeloma were treated with bortezomib （1.01.3 mg/m2） by intravenous bolus twice a week （day 1,4,8,11）,cyclophosphamide （0.3 g/m2） by intravenous inject in the same day,dexamethasone 40 mg/d in the same day the next day. This regimen was repeated every 28 days as one cycle. The patients had received one to four courses. Before each course we had a check-up of bone marrow hemocytology,M protein and β2-microglobulin level. The adverse events were also observed. Result：①Clinical response was 100%,including complete response in 8（28%） patients,near complete response in 2 patients,partial complete response in 13 patients and minimal complete response in 5 patients. ② Bone marrow hemocytology,M protein and β2-microglobulin level before treatment were all significantly different from those after treatment （P〈0.05）. ③The most common adverse events were gastrointestinal symptoms. Other adverse events included thrombocytopenia,herpes zoster and peripheral neuropathy. Conclusion：Bortezomib in combination with dexamethasone and cyclophosphamide is an effective therapy with a high response rate and tolerable toxicities for multiple myeloma patients.