不同剂量地塞米松联合沙利度胺治疗多发性骨髓瘤

Effectiveness of different doses of dexamethasone combined with thalidomide on multiple myeloma

目的 比较标准剂量地塞米松和小剂量地塞米松联合沙利度胺治疗多发性骨髓瘤（MM）的疗效和患者不良反应.方法 39例MM患者随机分成两组,均给予沙利度胺＋地塞米松方案化疗,沙利度胺200 mg/d,标准剂量组给予地塞米松40 mg第1天至第4天,28 d,小剂量组予地塞米松20 mg第1天至第4天,28d,共4个疗程.比较两组的疗效、生存情况和患者不良反应.结果 标准剂量组完全缓解5例（26.3%）、部分缓解7例（35.0%）、总有效率75.0%,小剂量组完全缓解3例（15.8%）、部分缓解7例（36.8%）、总有效率68.4%,两组差异无统计学意义（P〉0.05）,标准剂量组的肺部感染、血压升高、血糖升高、带状疱疹等不良反应均高于小剂量组,两组差异有统计学意义（P〈0.05）.结论 标准剂量组与小剂量组治疗MM疗效相近,但不良反应明显增多.

Objective To evaluate the efficacy and side effects of standard-dose of dexamethasone and low-dose dexamethasone combined with thalidomide in treatment of multiple myeloma. Methods Thirtynine patients with multiple myeloma were randomly divided into 2 groups, who were treated with chemotherapy of thalidomide （200 mg/d） plus dexamethasone （40 mg d1-46728 days in standard-dose group and 20 mg dl-4d/28 days in low-dose group）, for a total of 4 courses. The efficacy, survival time and adverse events were compared between the two groups. Results Complete remission rate, partial remission rate and overall response rate of the standard-dose group were 26.3 %, 35 % and 75 %, respectively; and those of the low-dose group were 15.8% , 36.8 % and 68.4 %, respectively. No statistical difference between the two groups （P 〉0.05 ） was observed. Lung infections, blood pressure elevation, blood glucose elevation, shingles and other adverse reactions in the standard-dose group were statistically higher than those in the low-dose group （P 〈0.05）. Conclusion Efficacy on multiple myeloma of standard-dose and low-dose dexamethasone are similar, but adverse reactions are significantly increased.