15例多发性骨髓瘤应用硼替佐米为主化疗方案治疗的临床疗效分析

Clinical efficacy of 15 patients with multiple myeloma treated with bortezomib combined regimen

目的:分析硼替佐米为主化疗方案治疗多发性骨髓瘤(MM)的临床疗效。方法:初治MM患者10例,复发、难治MM患者5例,均采用硼替佐米+地塞米松(PD)为主方案,每3周1个疗程。具体方案:10例初治患者采用硼替佐米1.3mg/(m2.d),静脉注射d1,4,8,11;地塞米松20mg/d静脉注射d1,2,4,5,8,9,11,12;5例复发、难治患者采用硼替佐米+吡柔比星+地塞米松(PAD)方案,每3周1疗程,硼替佐米1.3mg/(m2.d),静脉注射d1,4,8,11;地塞米松20mg/d静脉注射d1,2,4,5,8,9,11,12;吡柔比星9mg/(m2.d)静脉注射。所有患者分别接受1-6个疗程的治疗,继以沙利度胺100mg/d口服维持治疗。根据EBMT标准观察疗效。结果:平均随访15(3-33)个月。10例初治患者对治疗均有反应,其中CR/nCR 5例(50%),PR 4例(40%),MR 1例(10%)。5例复发、难治患者中CR 1例(20%),PR 1例(20%),MR 2例(40%),PD 1例(20%),初治组总体缓解率(CR/nCR+PR)高于复发难治组,P<0.05。最常见的毒副反应是胃肠道反应、血小板、白细胞减少,合并各种感染及周围神经病变等。结论:硼替佐米联合地塞米松为主的化疗方案治疗初治MM起效快,总体反应率与完全缓解率高;该方案用于复发、难治性MM亦有较高治疗反应率,但疗效逊于初治患者,其远期疗效有待进一步观察评价。不良反应可控制和预测,总体耐受性良好。

Objective：To investigate the efficacy of bortezomib in the treatment of multiple myeloma.Methods： Ten newly diagnosed multiple myeloma patients and five relapsed or refractory multiple myeloma（RRMM） patients were treated with bortezomib and dexamethasone.The regimen was repeated every 21 days as one cycle.Concrete regimen：10 newly diagnosed multiple myeloma patients were treated with bortezomib1.3mg/（m^2·d）by rapid intravenous injection（day 1,4,8,11） and dexamethasone（20mg/d） by intravenousdrip（day 1,2,4,5,8,9,11,12）.5 relapsed or refractory multiple myeloma（RRMM） patients were treated with bortezomib 1.3mg/（m^2·d）by rapid intravenous injection（day 1,4,8,11） and dexamethasone（20mg/d） by intravenousdrip（day 1,2,4,5,8,9,11,12）.In addition,5 relapsed or refractory multiple myeloma（RRMM） patients received the combination of perarubicin 9mg/（m^2·d）by intravenous injection（d1）.All the patients received one to six courses,followed by oral thalidomaide （100mg/d）for maintenance treatment.Response was evaluated according to EBMT criteria.Results： The result of 15 months（3-33months） median follow-up showed that clinical response in 10 newly diagnosed patients was 100%,including CR/nCR 5（50%）,PR 4（40%）and MR 1（10%）;In 5 patients with RRMM CR 1（20%）,PR 1（20%）,MR 2（40%）,PD 1（20%） were achieved.The overall response rate（CR/nCR＋PR） in newly diagnosed group was significantly higher than that in RRMM group,P0.05.The most common adverse events were gastrointestinal reactions,thrombocytopenia,leukopenia,infection and peripheral neuropathy.Conclusion：Bortezomib in combination with dexamethasone is an effective therapy for newly diagnosed multiple myeloma patients.The overall response rate and the CR rate are high.This regimen also contributes to a high response rate for RRMM,but the effect is inferior to newly diagnosed ones.The long-term efficacy needs further investigation.The adverse events are controllable and tolerable.