沙利度胺联合VAD方案治疗多发性骨髓瘤的临床疗效评估

Clinical Observation of Therapeutic Effect of Thalidomide Combined with VAD Chemotherapy on Multiple Myeloma

目的分析沙利度胺联合长春新碱(V)、多柔比星(A)和地塞米松(D)方案与单用VAD方案治疗多发性骨髓瘤(MM)的临床疗效及安全性。方法收集2011年3月至2012年3月在宝鸡市人民医院就诊的MM患者56例,根据治疗适应证和家属意见分为两组,治疗组(32例)患者接受沙利度胺联合VAD方案,沙利度胺起始剂量为50 mg,每周递增50 mg,最大剂量为200 mg,持续12周以上;对照组(24例)患者仅行VAD方案。观察两组的临床疗效和不良反应情况。结果治疗组总有效率显著优于对照组(87.5%vs 62.5%,P<0.05);治疗组血红蛋白、白蛋白显著高于对照组,浆细胞百分比显著低于对照组(P<0.05);两组的不良反应有皮疹、脱发、恶心和呕吐、肺部感染、骨髓抑制、便秘、一过性高血糖等,但患者均可耐受。结论沙利度胺联合VAD方案治疗MM的疗效优于单用VAD方案,疾病控制率高,可优先应用于治疗MM。

Objective To compare the therapeutic and side effect of combined VAD ＋ thalidomide regi- men with VAD alone in the treatment of multiple myeloma （ MM ）. Methods According to the treatment indications and families opinions ,56 MM cases admitted to Baoji Central Hospital from March 2011 to March 2012 were divided into treating group and control group. 32 cases of treating group were treated with thalido- mide combined with VAD chemotherapy, the initial dose of thalidomide was 50 mg/d, then increased by 50 mg/w to maximal 200 mg/d every week, and maintained for more than 12 weeks. 24 cases of control group were treated with VAD chemotherapy. The clinical effect and adverse effects of the two groups were observed. Results The total effective rate of the treating group （ 87.5 % ） was significantly higher than the control group（62.5% ） （ P 〈 0.05 ）. The adverse effects in both groups were skin rash, alopecia, nausea and vomi- ting,pulmonary infection, myelosuppression, constipation, transient hyperglycemia etc. , but all the adverse effects were endurable. Conclusion Thalidomide combined with VAD chemotherapy was more effective than VAD therapy with higher disease control rate, which can be preferable choice for the treatment of MM.