硼替佐米联合表柔比星及地塞米松方案治疗多发性骨髓瘤临床观察

Bortezomib combined with epirubicin and dexamethasone in treatment of multiple myeloma

目的观察硼替佐米联合表柔比星及地塞米松(PAD方案)治疗多发性骨髓瘤(multiple myeloma,MM)的疗效和安全性。方法共有103例MM患者接受过2～10个疗程PAD方案化疗。PAD方案:硼替佐米(万珂)1.0～1.3 mg/m2,在第1、4、8天和l1天给药,在3秒内快速静脉注射;表柔比星9 mg/m2,在第2、5、9天和l2天给药;每次静脉注射硼替佐米当天及次日即第1、2、4、5、8、9、11天和12天,给予地塞米松20 mg加入0.9%生理盐水250 mL中静脉滴注,每28天为1个疗程。观察疗效和不良反应。结果总体反应率[完全缓解(CR)+接近完全缓解(nCR)+部分缓解(PR)+轻微反应(MR)]为88.3%(91/103),治疗有效率(CR+PR)为73.8%(76/103)。其中有32例在PAD方案治疗前接受过PD方案治疗的患者,23例有效,治疗有效率(CR+PR)为71.9%(23/32)。最常见的血液系统不良反应包括白细胞减少、贫血、血小板减少。非血液学不良反应主要为乏力、外周神经病变、腹泻/便秘等消化道症状、带状疱疹、呼吸道感染、浆膜腔积液/浮肿、血栓形成、皮疹、溶血等,经对症处理或延长化疗间歇时间后均可以减轻或恢复。结论 PAD方案在初发或难治复发的多发性骨髓瘤中均有较好的疗效,同时具有良好的安全性和耐受性。优于单药万珂或PD两药联合,可作为多发性骨髓瘤治疗的首选。

Objective To study the efficacy and safty of PAD regimen （bortezomib plus epirubicin and dexamethasone） for multiple myeloma（MM）. Methods A total of 103 multiple myeloma （MM） patients received PAD regimen for 2 to 10 cycles. PAD regimen consisted of： bortezomib 1.0 to 1.3 mg/m2 , intravenous injection within 3 seconds on day 1,4,8 and 11 ; epirubicin 9 mg/m2 , on day 2,5,9 and 12 ; dexamethasone 20 mg, intravenous on day 1,2,4,5,8,9,11 and 12. Every 28 days was considered as a cycle of treatment and therapeutic response and adverse reactions were observed. Results The total response rate [ complete response （CR） ＋ near complete remission （nCR） ＋ partial response （PR） ＋ minimal reaction （MR）] was 88.3% （91/103）,effective rate（CR ＋ PR） was 73.8% （76/103）. Among the 103 cases,32 received PD regimen before,of which 23 cases were effectual. The effective rate （CR ＋ PR） was 71.9% （23/32）. The most common hematologic adverse reactions were leukopenia, anemia and thrombocytopenia. Non-hematologic adverse reactions were mainly hypodynamia, peripheral neuropathy, diarrhea, constipation, herpes zoster, respiratory infections, dropsy of serous cavity, thrombosis, skin rashes, hemolysis, etc. All of those were recovered after symptomatic treatment or by prolonging the intermittent period of chemotherapy. Conclusions PAD regimen is safe, effective and tolerable for the treatment of either newly diagnosed or relapse/refractory MM patients. PAD regimen is better than the single medicine bortezomib or PD regimen and should be considered as the first choice in the multiple myeloma treatment.