硼替佐米联合地塞米松治疗多发性骨髓瘤患者的效果观察

Efficacy of zomib in combination with low dose of dexamethasone on multiple myeloma patients

目的了解硼替佐米联合小剂量地塞米松对多发性骨髓瘤（Multiple myeloma,MM）患者的疗效及成骨作用。方法对12例MM患者采用硼替佐米联合小剂量地塞米松的治疗方案,采用EBMT标准评价其疗效;并对所有患者采用双能X线骨密度仪（DXA）,测量其治疗前后的骨密度（BMD）值。结果总缓解（CR＋nCR＋PR）率为75%：2例CR、4例nCR、3例PR、2例MR、1例NC;治疗后患者全身、L2~4椎体正侧位及左股骨近端的BMD值（分别为0.64±0.11,0.69±0.12,0.61±0.09）较治疗前对应的BMD值（分别为0.57±0.10,0.47±0.08,0.52±0.04））明显增高,两组比较差异有统计学意义（t值分别为2.38,4.80,2.63,P值分别为0.029,0,0.021）;最常见的毒副反应为乏力8例,周围神经病变2例,血小板减少症2例,胃肠道反应2例,分别经对症治疗后患者的毒副反应均缓解。结论硼替佐米联合小剂量地塞米松治疗多发性骨髓瘤是一种疗效确切,且在体内具有成骨作用,副反应少的治疗方案。

Aim To investigate the efficacy and remodeling of bortezomib in combination with dexamethasone in treatment of patients with multiple myeloma（MM）.Methods Twelve MM patients were treated with bortezomib 1.30mg·m-2 by intravenous and dexamethasome 20～40 mg by intravenous injection twice a week for 2weeks in a course of 21 days.Response to bortezomib evaluated according to the criteria of the European Group for Blood Marrow Transplantation（EBMT）,and use the Dual energyX-ray absorptiometry（DXA） to measure the bone mineral density（BMD）befor and after the treatment of MM patients.Adverse events were graded according the National Cancer Institute Common Toxicity Criteria.Results The median follow-up duration from the beginning of bortezomib treatment was 4.5（2.7~12） months.Clinical response was observed in 9 patients（75%）,complete response in 2 patients,near complete response in 4 patients,partial response in 3,minimal response in 2 and nochange in 1 inpatients.After this treatment,the BMD of the whole body（0.64±0.11）,vertebrate L2～L4（0.69±0.12） and the proximal left femur（0.61±0.09）increased significantly more than those before treatment（0.57±0.10,0.47±0.08,0.52±0.04）（t =2.38,4.80,2.63,P=0.029,0.0.021）.The most common adverse events were fatigue,peripheral neuropathy（2patinets）,thrombopenia（2 patients）,and gastrointestinal symptoms（2patients）.The adverse events were subsided on routine supportive care.Conclusion Bortezomib in combination with 4 dose of dexamethasone is effective on MM patients with less adverse events and remodel in bone destruction.