硼替佐米联合异环磷酰胺、甲泼尼龙、沙利度胺方案治疗多发性骨髓瘤

Effects of bortezomib combined with ifosfamide, methylprednisolone and thalidomide for thetreatment of multiple myeloma

目的观察硼替佐米联合异环磷酰胺、甲泼尼龙、沙利度胺（V-CMPT方案）治疗多发性骨髓瘤（MM）的临床疗效和患者不良反应。方法回顾性分析应用V—CMPT方案进行治疗的24例初治和复发难治MM患者资料，3周为1个周期，治疗2个周期。应用骨髓细胞学检查、M蛋白鉴定以及其他血液学指标评价病情及疗效。结果初治的9例患者中，完全缓解（CR）3例、部分缓解（PR）5例、轻微缓解（MR）1例；复发难治的15例患者中，CR2例、接近完全缓解（nCR）2例、PR3例、MR6例、无变化（NC）2例；两组间总缓解率（ORR）（P=0．511）及CR／nCR率（P=1．000）差异无统计学意义。总的CR／nCR率29．2％（7／24），ORR达到91．7％（22／24）。2个周期V—CMPT化疗后，患者的血红蛋白、血清清蛋白及血清8：微球蛋白得到明显改善。不良反应包括胃肠道反应、血小板减少、周围神经病变等，经对症处理或间歇期停药多好转，不影响化疗的继续进行。结论V—CMPT方案对初治和复发难治性MM临床疗效明显，能够明显改善血液学指标，药物耐受性良好。

Objective To investigate the efficacy and toxicity of bortezomib in combination with ifosfamide, methylprednisolone, thalidomide （V-CMPT） for the treatment of multiple myeloma （MM）. Methods Twenty-four patients with newly diagnosed or relapsed/refractory MM were treated with V-CMPT. This regimen was repeated every three weeks as one cycle, and each case received two cycles. We adopted the examination of bone marrow and M protein and other hematological markers to evaluate the condition of disease and the therapeutic response. Results Of the nine patients with newly diagnosed MM, three achieved a complete remission （CR）, five of a partial response （PR）, and 1 of a minor response （MR）. Of the patients with relapsed/ refractory MM, two achieved a CR, two had a near CR （nCR）, three had a PR, six had a MR, and two were no chang （NC）. There was no obvious difference in the two groups （P = 0.511, P = 1.000）. The overall response rate （ORR） was 91.7 %, and the CR/nCR rate was 29.2 %. After two cycles, the levels of hemoglobin, the serum albumin and the serum β2-microglobulin were obviously improved. The main adverse events were transient, including gastrointestinal reaction, thrombocytopenia, neuropathy, which could be controlled during the interval of chemotherapy or by symptomatic treatment and had no influence on the chemotherapy. Conclusion V-CMPT regiman was effective against the newly diagnosed and relapsed/refractory MM and could improve the related hematological markers with high response rate and tolerable toxicities.