PAD和VAD治疗多发性骨髓瘤的副作用评价

Adverse Effects of PAD and VAD Regimens in Multiple Myeloma Patients

本研究评价PAD(硼替佐米、阿霉素、地塞米松)和VAD(长春新碱、阿霉素、地塞米松)两种方案治疗多发性骨髓瘤的副作用。有27和30例多发性骨髓瘤患者分别入组PAD和VAD治疗组,各组分别采用PAD和VAD方案治疗3-5疗程。观察两组患者治疗副作用的类型、程度及发生时间。结果表明:在治疗过程中,皮疹是PAD组中特有的现象。两组患者共同的不良反应类型包括白细胞和血小板减少、周围神经病变、感染、疲乏、恶心、便秘、皮质激素相关副作用(血压增高、血糖增高、低钾血症、低钠血症、痤疮)等,两组患者在治疗过程中均未发生血栓形成。虽然统计学分析显示,仅血小板减少在两组中差异有显著性意义,但从发生率上看,PAD组患者在白细胞减少、周围神经病变以及疱疹病毒感染的发生率方面高于VAD组。从副反应发生的时间上看,皮疹、便秘、周围神经病变和皮质激素的副作用在第1疗程治疗中即可发生,而其他不良反应多数在3个疗程治疗后出现。终止治疗的主要原因包括感染和不能耐受的周围神经病变。对后者而言,虽然两组均有发生,但只有PAD组的2例患者在3个疗程后中止治疗。结论:PAD在提高疗效的同时,副反应发生率可能更高,并有可能因此而中断或延期治疗,因此在治疗中应给予高度重视,积极预防。

The study was aimed to evaluate the adverse effects of PAD （ bortezomib ＋ adriamycin ＋ dexamethasone） and VAD （ vincristine ＋ adriamycin ＋ dexamethasone） as chemotherapy regimens in multiple myeloma patients. 27 and 30 patients with multiple myeloma （MM） were enrolled in PAD and VAD groups respectively. MM patients accepted 3 - 5 cycles of VAD or PAD regimens. The type, degree and occurrence time of adverse reactions during the treatment were observed. The results showed that the rash was found in two patients only in PAD group, leucocytopenia, thrombocytopenia, peripheral neuropathy, infection, fatigue, nausea, constipation, and adverse effects of cortex hormone （hypertension, glycohemia, hypokalemia, hyponatremia and acne） were found in the both two groups. The thrombosis was not observed in both two groups during treatment. Although statistical analysis indicated that only the inciddhce of thrombocytopenia was higher in PAD group than in VAD group with statistical difference but the incidence of leucocytopenia, peripheral neuropathy and infection in PAD group were higher than those in VAD group. Rash, constipation, peripheral neuropathy could be found in the first course of chemotherapy, while the others mostly emerged after 3 courses of treatment. The main reasons for the patients who＇s treatment was stopped include infection and untolerable peripheral neuropathy. Although peripheral neuropathy could be found in the two groups, but the chemotherapy was stopped only in 2 patients of PAD group after 3 cycles of treatment. It is concluded that compared with conventional VAD chemotherapy, PAD may improve therapeutic effect, but it may bring more severe toxicities to the patients with multiple myeloma.