沙利度胺联合VAD治疗难治或复发性多发性骨髓瘤的临床观察

The Clinical efficacy of thalidomide combined with VAD in treatment of relapsed or refractory multiple myeloma

目的观察沙利度胺联合VAD治疗难治性或复发性多发性骨髓瘤(MM)的临床疗效及不良反应。方法 49例患者难治性或复发性MM患者随机分为沙利度胺联合VAD组(n=25)和VAD组(n=24)。A组:25例患者接受沙利度胺联合VAD化疗方案(VAD:(长春新碱0.4 mg/d静脉注射,第1～4 d;多柔比星10 mg/d静脉注射,第1～4 d;地塞米松40 mg/d口服,第1～4d,9-12 d和第17～20 d);沙利度胺200 mg/d口服)。B组:24例患者接受VAD方案(同上)。每治疗周期为28 d,持续4个周期后评价治疗效果。结果 A组和B组最终病例数分别为25例和23例(B组1例男性患者死亡)。2组的治疗有效率分别为80%和47.8%,A组的疗效明显优于B组(P<0.05)。A组较B组更容易产生便秘、嗜睡(P<0.05),2组患者的副反应程度均可耐受。结论沙利度胺联合VAD较单纯VAD方案治疗难治性或复发性MM具有更好的治疗效果,患者能够很好的耐受。

Objective To investigate the clinical responses and the side-effects of thalidomide combined with VAD in treating patients with relapsed or refractory multiple myeloma（MM）.Methods Forty-nine patients with relapsed or refractory MM were randomly divided into two groups.Group A（n=25） received treatment of thalidomide（given daily at a dose of 200 mg） combined withVAD（vindesine 1-2 mg intravenously on days 1-4;liposomal doxorubicin 20 mg/d i.v.administered on days 1-4;dexamethasone 40 mg per os daily on days 1-4 and 15-18）,and 24 patients（group B） were given chemotherapeutic regimen VAD,which is the same regimen as regimen A without thalidomide.Response to treatment was evaluated after four cycles of treatment（one cycle persisted 28 days）.Results The final number of patients in group A was 25 and B was 23（one male patient died）.The overall response rate of the group A and group B was 80% and 47.8%（P〈0.05）,respectively.In terms of constipation and somnolence,group A showed a higher incidence compared to group B（each,P〈0.05）.These two regimens were easy to tolerate.Conclusion Regimen A in patients with relapsed or refractory MM is more effective compared to regimen B in terms of its comparable response rate.This therapy has mild adverse reactions and is easy to tolerate.