BTD、MPT方案序贯治疗新诊断的非移植多发性骨髓瘤患者的疗效分析

Sequential therapy of BTD and MPT regimen for the newly-diagnosed multiple myeloma patients no eligible for bone marrow transplantation

目的回顾性总结BTD与MPT方案序贯治疗新诊断的非移植多发性骨髓瘤（MM）患者的临床疗效及不良反应。方法选取2006年1月至2010年5月应用BTD、MPT方案序贯治疗的新诊断非移植MM患者36例为研究对象，其中BTD方案诱导治疗至少2个疗程，达到部分缓解（PR）及其以上疗效后，改用MPT方案巩固治疗至少2个疗程，再应用小剂量沙利度胺维持治疗，直至疾病复发、进展。观察患者疗效及不良反应。结果应用BTD方案诱导治疗的36例MM患者中，7例（19．4％）获得完全缓解（CR），8例（22．2％）获得非常好的部分缓解（VGPR），14例（38．9％）获得PR，总缓解（OR）率为80．6％。29例有效（CR＋VGPR＋PR）患者应用MPT方案维持治疗，1例VGPR患者获得CR，3例PR患者获得VGPR，4例（1例既往CR，1例VGPR，2例PR）出现复发进展，其余患者病情平稳。在应用小剂量沙利度胺维持治疗的25例患者中，3例出现进展，其中2例死亡，其余患者病情稳定。中位随访16．5（2。46）个月，中位无进展生存期（PFS）尚未获得，预期1年生存率为86．0％，3年生存率为77．0％。不良反应主要包括血小板减少、周围神经病变、带状疱疹、胃肠道反应、贫血、感染、便秘、疲乏、皮疹等。3～4度不良反应发生率较低。结论BTD、MPT方案序贯治疗可以用于新诊断的非移植MM患者的一线治疗。

Objective To retrospectively analyze the outcomes and adverse effects of sequential therapy of BTD and MPT regimen for the newly-diagnosed multiple myeloma patients no eligible for high dose chemotherapy and stem cell transplantation. Methods Thirty-six patients were involved in this study and the patients were treated with tandem therapy of BTD and MPT regimen. The patients were treated with BTD regimen as induced therapy no less than 2 cycles. When the patients got PR or above PR, they were treated with MPT regimen as consolidation therapy which was no less than 2 cycles. Then, the patients who achieved PR or partial PR were received MPT chemotherapy regimen as consequent treatment. After that, low dose thalidomide was used as maintenance therapy. The outcomes and adverse effects were retrospectively evaluated. Results Thirty-six patients were treated with BTD regimen as induced therapy. The results were that 7 patients （19.4 %） achieved CR, 8 （22.2 %） VGPR, 14 （38.9 %） PR and the OR rate was 80.6 %. The patients （n=29） who achieved no less than PR was treated with MPT regimen as consequent therapy. The resuhs were that four patients were in progression and the others were stable. Twenty-five patients were treated with low dose thalidomide as maintenance therapy. The median progression-free survival （PFS） did not reached yet until last follow-up （median follow-up time was 16.5 months）. One-year overall survival rate was expected 86.0 % and 3-year expected overall survival rate was 77.0 %. The main regimen-associated toxicities included thrombocytopenia, peripheral ueuropathy （PN）, Herpes Zoster, gastrointestinal symptoms, anemia, neutropenia, constipation, fatigue, rash and so on. The incidence of grade 3 and 4 adverse events was low. Conclusion Sequential therapy of BTD and MPT regimen can be used as the front-line therapy for the newly-diagnosed multiple myeloma patients no eligible for high dose chemotherapy and stem cell transplantation.