硼替佐米联合化疗对多发性骨髓瘤的疗效与相关血液学指标分析

Effect of bortezomib in combination with chemotherapy on multiple myeloma and change in its hematological indexes

目的观察硼替佐米治疗多发性骨髓瘤(multiple myeloma,MM)的疗效及血液学指标的改变。方法2007年4月至2009年12月本院血液病中心收治的18例多发性骨髓瘤患者,其中7例初治患者与11例复发难治患者,均采用以硼替佐米为主的联合方案化疗,3周为1个疗程,每例患者至少接受1～6个疗程的治疗。观察疗效及相关血液学指标的改变。结果7例初治患者中5例患者完全缓解(CR),后1例行自体造血干细胞移植,2例患者获得部分缓解(PR)。11例复发难治患者中7例达CR,2例达PR,2例无效。患者浆细胞比例、血清总蛋白含量(TP)、球蛋白(G)、M蛋白含量、尿蛋白、β2-微球蛋白、乳酸脱氢酶(LDH)、肌酐(Cr)、尿酸(UA)等随化疗周期呈明显下降趋势,患者血红蛋白(Hb)、白蛋白(Alb)含量、A/G比值等呈明显的上升趋势。不良反应多为1～2级,常为一过性,包括周围神经病变(4/18)、骨痛(1/18)、胃肠道反应(8/18),经对症治疗后均好转。结论硼替佐米对初发及难治复发多发性骨髓瘤的治疗均有较好疗效,对治疗相关不良反应患者可耐受,相关血液学指标改善明显。

Objective To observe the therapeutic effect of bortezomib on multiple myeloma （MM） and the change in its hematological indexes.Methods Of the 18 patients with MM admitted to Hematopathy Center,Third Military Medical University from April 2007 to December 2009,7 had newly diagnosed MM and 11 had relapsed or refractory MM.MM was treated with bortezomib in combination with chemotherapy,3 weeks a course,for at least 1 to 6 courses,to observe its effect and change in hematological indexes.Results Complete remission （CR） of MM was achieved in 5 out of the 7 patients with newly diagnosed MM.Of the 5 patients,1 received autologous hematopoietic stem cell transplantation and 2 had a partial response （PR）.Of the 11 patients with refractory or relapsed MM,2 had a PR,7 had CR,and 2 had no response （NR）.The number of plasma cells and the levels of serum total protein （TP）,globulin （G）,M protein,urine protein,β2-microglobulin,lactate dehydrogenase （LDH）,creatinine （Cr）,and urine acid （UA） decreased significantly with the cycle of chemotherapy.However,the hemoglobin （Hb） and albumin （Alb） level and A/G ratio increased significantly.The main side effects included peripheral neuropathy,ostealgia and gastrointestinal disorders,which were transient and improved after treatment.Conclusion Bortezomib is effective against newly-diagnosed refractory and relapsed MM,with acceptable side effects,and can significantly improve the related hematological indexes.