硼替佐米治疗多发性骨髓瘤疗效及影响因素分析

Therapeutic efficacy and influencing factors of bortezomib treatment for multiple myeloma

目的观察硼替佐米治疗多发性骨髓瘤(Multiple myeloma,MM)的疗效及影响因素。方法初治MM患者18例,复发、难治MM患者13例,均接受硼替佐米联合地塞米松(VD)方案治疗,21 d为1个疗程。结果平均随访14(6～36)个月,总反应率77.6%,完全缓解率(CR)6.45%、非常好的部分缓解率(VGPR)22.6%、部分缓解率(PR)48.4%。初治组疗效优于复发难治组;轻链型患者总反应率和CR率均明显高于非轻链型患者。发病或治疗过程中出现严重贫血、血β2微球蛋白(β2-MG)增高、高钙血症和肾功损害者,多数出现疾病进展,是死亡的主要原因。不良反应主要为胃肠道症状、周围神经病变、血小板减少、感染等,经对症治疗或推迟化疗后均可恢复。结论硼替佐米对初发及难治复发多发性骨髓瘤的疗效较好,对治疗相关不良反应患者可耐受,在轻链型患者疗效更加显著。有严重贫血、β2-MG升高、肾功能损害、高钙血症的患者治疗效果不理想,其远期疗效有待进一步观察评价。

Objective To explore the therapeutic efficacy and influencing factors of bortezomib treatment for multiple myeloma. Methods 18 cases of treatment-naive patients （ group A） and 13 cases of patients with relapsed or refractory multiple myeloma（ group B ） were both treated with bortezomib in combination with dexamethasone（VD） for 21 d （a treatment course）. Results Average follow-up time was 14 （6 -36）months. The overall response rate （ORR） was 77. 6% ,and complete remission rate （CR）, very good partial remission rate （VGPR）and partial remission rate （PR）was 6. 45% ,22. 6% and 48.4% respectively. The therapeutic efficacy in group A was superior to that in group B. The ORR rate and CR rate of patients with light chain type multiple myeloma were obviously higher than those in patients with non-light chain type multiple myeloma. Severe anemia, increased blood β2 microglobulin （β2-MG）level, hypercalcinemia and renal disfunction could be observed in the process of incidence and treatment. Most patients would undergo disease progression and those were main causes leading to death. The major adverse reactions included gastro- intestinal symptoms, peripheral neuropathy, thrombocytopenia and infection and so forth. Patients with adverse reactions above would recover by symptomatic treatment or postponed chemotherapy. Conclusion The therapeutic efficacy of bortezomib treatment for patients with treatment-naive, relapsed or refractory multiple myeloma are all satisfactory, and patients can be tolerant to the treatment related adverse reactions. The therapeutic efficacy for those patients with light chain type multiple myeloma is more notable. However, the therapeutic for the patients with severe anemia, increased blood β2-MG level, renal disfunction and hypercalcinemia is unexpected. The longterm therapeutic efficacy for those patients＇ needs further observation and assessment.