硼替佐米联合表柔比星在初诊多发性骨髓瘤中的临床应用

The Efficacy of Bortezomib Plus Epincbicin in Treatment of Newly Diagnosed Multiple Myeloma

目的比较硼替佐米联合表柔比星及地塞米松方案（PAD）与长春新碱联合阿霉素和地塞米松方案（VAD）治疗初诊多发性骨髓瘤（MM）的疗效及毒副反应。方法64例初诊MM患者，分2组，1组30例采用硼替佐米1．3mg／m2，分别于1、4、8、11d给药，表柔比星10mg／d×4d，地塞米松40mg／d×8d。另1组34例MM患者采用传统VAD方案，静脉点滴长春新碱0．5mg／m2，1～4d，阿霉素10mg／d×4d，地塞米松20mg／dX8d，两组患者均治疗3个疗程后，比较疗效和不良反应。结果PAD组总有效率（ORR）为86．7％（26／30），完全缓解率（CR＋nCR）为33．3％（10／30），明显高于VAD组的41．2％（14／34）和5．9％（2／34）。PAD组毒副反应主要是血液学毒性，胃肠道反应，周围神经病变，经对症治疗后大多能改善。VAD组主要毒副反应为感染，脱发以及静脉炎。结论PAD方案对于初诊MM患者的治疗效果显著优于VAD方案，其总有效率高，毒副作用小，有效延长了患者的生存期，值得推广。

Objective To study efficacy and toxicity in two groups of patients with untreated multiple myeloma（MM） receiving bortezomib combined with epincbicin and dexamethasone（PAD）,vincristine combined with adriamycin and dexamethasone（VAD）.Methods In 64 patients with newly diagnosed MM,30 patients were enrolled the treatment of PAD,receiving bortezomib 1.3mg/m2,on days 1,4,8 and 11,and epincbicin 10mg/ day＊4,dexamethasone 40rag on days 8.Another 34 patients received VAD,21 days as a cycle,compared with the efficacy after 3 cycles.Results After bortezomib-based combinations,26 of 30 patients（86.7%） achieved at least a partial response,including complete response and near complete response in l0 patients（33.3%）.Side effects in the PAD group were mainly haematologic,gastrointestinal,and peripheral neuropathic and infection,baldness,phlebop- hlogosis in VAD group.Conclusions PAD therapy is an effective and safe induction regimen for newly diagnosed MM patients and appears significantly superior to VAD.