雷利度胺为主方案治疗多发性骨髓瘤25例疗效分析

Effectiveness of lenalidomide-based chemotherapy on 25 patients with multiple myeloma

目的 观察雷利度胺为主方案治疗多发性骨髓瘤（MM）患者的疗效及不良反应.方法 MM患者25例.其中5例为初治患者,13例为含沙利度胺方案治疗后难治、复发患者,7例为治疗后达平台期维持治疗患者.初治MM患者均采用R-PAD方案,难治、复发患者选用R-MD方案,维持治疗MM患者由于出现Ⅱ级伴疼痛以上的周围神经炎（PN）,采用雷利度胺单药治疗.结果 初治组5例,经过2个疗程的治疗均达到完全缓解（CR）（100%）;难治、复发组13例,CR率为23.08%（3/13）,非常好的部分缓解（VGPR）率为15.38%（2/13）,部分缓解（PR）率为38.46%（5/13）,总反应率（ORR）为76.92%（10/13）;其余3例无反应患者中,2例疾病稳定（SD）,1例疾病进展（PD）.维持治疗组7例在平均38周的随访期内均维持缓解;改用雷利度胺后,PN获得不同程度的缓解.结论 对于初治MM患者,R-PAD方案缓解率高.起效快;对于难治、复发患者,特别是伴严重PN的MM患者,R-MD是值得选择的方案;雷利度胺还可用于伴PN的MM患者的维持治疗.

Objective To evaluate the efficacy and safety of lenalidomide（Len）-based regimens in the treatment to patients with multiple myeloma （MM）. Methods Twenty-five multiple myeloma patients who received Len-based regimens were enrolled in this study. There were 5 newly-diagnosed MM patients, 13 relapsed/refractory （rel/ref） MM and 7 MM patients at plateau after treatment. The newly-diagnosed patients received R-PAD regimen, rel/ref MM received R-MD and the patients at plateau（maintenance treatment group） due to more than 2 grade peripheral neuropathy （PN） received Len monotherapy. Results All of the five newly-diagnosed MM achieved complete remission （CR） （100 %） after 2 courses of theatment; of 13 rel/ref patients （76.92 %） achieved overall response, including 3 （23.08 %） achieving CR, 2 （15.38 %） very good partial response （VGPR）, 5 （38.46 %） partial response （PR） and the overall response rate was 76.92 %. Two of the other three no response patients had stable disease（SD） and one had progress disease（PO）. The seven patients in maintenant treatment group maintained remission in an average follow-up period of 38 weeks and their PN was relieved in various degrees. Conclusion R-PAD regimen is a highly active regimen for newlydiagnosed MM and R-MD regimen is a promising regimen for rel/ref MM, especially for the patients with serious PN; Len may be a good choice as maintenant chemotherapy for the patients with PN.