MPT与MP方案治疗老年多发性骨髓瘤的疗效比较

Comparison of clinical efficacy between MPT and MP in elderly patients with multiple myeloma

目的:比较沙利度胺联合美法仑+泼尼松方案(MPT)与美法仑+泼尼松方案(MP)治疗多发性骨髓瘤(MM)的疗效与不良反应。方法:对37例接受MP或MPT治疗的初发MM老年患者的临床资料进行回顾性分析。根据接受治疗方案的不同随机分为MPT组和MP组。MPT组20例,美法仑每天4mg.m-2口服,第1～7天;泼尼松每天40mg.m-2口服,第1～7天;沙利度胺自化疗开始给药100～200mg.d-1,每28d为1个疗程。MP组17例,美法仑+泼尼松用法用量同MPT组。4～6个疗程后评估疗效。结果:MPT组的总有效率(ORR)为65%,明显高于MP组的41.2%(P<0.05)。MPT组中位反应时间为2个月,MP组中位反应时间为3.5个月。MPT组Ⅰ-Ⅱ度不良反应发生率高于MP组(50%vs 24%,P<0.05),MPT组和MP组的Ⅲ-Ⅳ度不良反应发生率无差别。结论:与MP方案相比,MPT治疗老年MM总有效率明显增高,治疗反应时间缩短,不良反应发生率增高,但无严重不良反应,耐受性良好。

Objective To compare the therapeutic efficacy and adverse effects of melphalan and prednisone plus thalidomide regimen（MPT） with melphalan and prednisone regimen（MP） in the treatment of patients with multiple myeloma（MM）.Methods 37 elderly patients newly diagnosed as MM were treated with MPT or MP.The patients were divided into two groups according to the treatment regimen.MPT group（20 patients）： melphalan 4 mg·m-2·d-1,d 1-7,prednisone 40 mg·m-2·d-1,d 1-7,thalidomide 100-200 mg·d-1,every 28 d for 1 cycle.MP group（17 patients）： the doses of melphalan and prednisone were the same as that in MPT group.The efficacy was evaluated after 4-6 cycles of treatment.Results The overall response rate（ORR） of the patients in MPT group was significantly higher than that in MP group（65% vs 41.2%,P0.05）.The median time to response in MPT group was shorter than that in MP group（2 months vs 3.5 months,P0.05）.The incidence of grade Ⅰ-Ⅱ side effects in MPT group was higher than that in MP group（50% vs 24%,P0.05）.However,there was no difference in the incidence of grade Ⅲ-Ⅳ side effects between two groups.Conclusion Compared with MP regimen,the ORR of MPT is significantly increased,the time of response to treatment is markedly shorten.The incidence of adverse reactions is higher in MPT group,but there is no difference in the incidence of grade Ⅲ-Ⅳ side effects between MPT group and MP group,and the patients can tolerate well.