硼替佐米治疗多发性骨髓瘤的临床观察

Clinical study of bortezomib in treatment of multiple myeloma

目的:观察硼替佐米治疗多发性骨髓瘤(MM)的疗效及不良反应。方法:5例初治的MM患者接受硼替佐米联合地塞米松治疗,6例复发难治骨髓瘤患者接受VDT方案(硼替佐米+地塞米松+反应停)化疗,每例患者至少接受中位3个周期(1～6个周期)的化疗。评价疗效及不良反应。结果:中位随访9个月,5例初治患者中2例完全缓解(CR),2例部分缓解(PR),1例轻微缓解(MR);6例复发难治患者中,3例PR,1例MR,2例无改变(NC)。总反应率(ORR=CR+PR+MR)为81.8%(9/11)。主要不良反应:10例(90.9%)胃肠道症状,8例(72.7%)血小板减少,7例(63.6%)白细胞减少,4例(36.3%)周围神经病变等,经对症治疗及调整用药剂量后均能改善。结论:硼替佐米用于治疗初发及复发难治MM是一种有效的新的治疗选择,不良反应较少且易于处理。

OBJECTIVE：To investigate the efficacy and toxicity of bortezomib in the treatment of patients with multiple myeloma （MM）. METHODS：Bortezomib combined with dexamethasone was administered as first-line treatment in all 5 newly diagnosed patients with multiple myeloma. Six patients with refractory and relapsed MM were treated with bortezomib in combination with dexamethasone and thalidomide （VDT regimen）. The patients received a median of 3 （1 to 6） cycles of chemotherapy at least. The response to bortezomib was evaluated and adverse events were graded. RESULTS：The median follow-up duration was 9 months. Out of 5 patients two achieved complete response（CR）,two achieved partial response （PR） and one achieved minor response（MR）.The 6 patients with refractory/relapsed myeloma achieved PR （3/6）,MR（1/6） and NC （no change） （2/6）. The overall response rate （ORR=CR＋PR＋MR） was 81.8%（9/11）. The main adverse events included gastrointestinal symptoms （90.9%）,thrombocytopenia （72.7%）,leucopenia （63.6%）,and peripheral neuropathy （36.3%）. The adverse events were subsided on routine supportive care. CONCLUSION：Bortezomib is effective and has manageable toxicity in the treatment of patients with newly diagnosed and relapsed/refractory multiple myeloma.