硼替佐米为主的化疗方案治疗多发性骨髓瘤50例临床分析

Clinical Analysis of Bortezomib -based Chemotherapy in Treatment of 50 Cases With Multiple Myeloma

目的:研究硼替佐米(万珂)为主的化疗方案治疗多发性骨髓瘤(MM)的疗效和安全性。方法:收集近4年来我科住院和随访的MM患者91例的临床资料,其中50例接受万珂为主化疗方案(VDT组);41例接受传统化疗方案(VADT)。分析并比较2组患者的年龄、性别、β2-微球蛋白值、白蛋白值和2组的缓解率及不良反应。疗效评价按照欧洲骨髓移植协作组(EBMT)标准。结果:2组患者的年龄、性别、疾病分期无明显差异。中位随访20个月,发现VDT组50例患者总体反应率为88%,平均2个疗程即起效。其中初治患者CR+nCR率明显优于同组复发难治患者以及传统方案治疗组,且初治患者的总缓解率在VDT组与VADT组中存在显著差异。VDT组不良反应以周围神经病变和血小板减少为常见,经对症治疗均可缓解。结论:万珂为主的化疗方案治疗初治和复发难治MM患者,起效快,其中初治患者CR+nCR率及总缓解率更高,其不良反应可耐受。对有不良核型和IgD型MM患者,如何提高疗效尚待研究。

Objective： To investigate the efficacy and safety of Bortezomib （Velcade） -based chemotherapy in treatment of multiple myeloma （MM）. Methods： Clinical data of 91 patients with MM admitted in our department and followed-up in recent years were collected, of those 50 cases received Velcade-based regimen treatment （VDT group）, and 41 cases received conventional chemotherapy （VADT） treatment. Patients＇ age, gender, β2-microglobin, albumin, as well as remission rate and adverse reactions were compared and analyzed between two groups. The efficacy was evaluated according to the criteria of European Bone Marrow Transplant. Results： There were no significant differences in age, gender and stage of MM between two groups. The median follow-up time was 20 months. The overall response rate of VDT was 88%, with an average onset time of 2 courses. The CR and nCR rate of the primary VDT treatment groups were significantly superior to relapsed patients of the same group and the traditional regimen （VADT） groups. And the overall remission rates of newly diagnosed patients were significantly different between VDT groups and VADT groups. The peripheral neuropathy and thrombocytopenia were common in VDT groups but were easily alleviated after symptomatic treatments. Conclusions： Velcade-based chemotherapy are with rapid onset of effect in treatment of newly diagnosed and relapsed MM patients, of those newly diagnosed patients achieve better CR＋nCR rate and higher overall remission, adverse reactions can be tolerated. How to improve the efficacy of MM patients with adverse karyotypic or IgD-type need further study.