PAD与T-VAD方案治疗初治多发性骨髓瘤的疗效与安全性分析

Efficacy and Safety of PAD and VAD Combined with Thalidomide in the Treatment of Newly Diagnosed Multiple Myeloma

目的:探讨PAD方案(硼替佐米、阿霉素和地塞米松)与T-VAD方案(沙利度胺联合长春地辛、阿霉素、地塞米松)治疗初治多发性骨髓瘤的疗效与安全性。方法:回顾分析47例初治多发性骨髓瘤患者的治疗情况,其中PAD治疗组23例,TVAD治疗组24例。结果:PAD治疗组总有效率91.3%(21/23),其中完全缓解(complete response,CR)8例(34.8%),很好的部分缓解(very good partial response,VGPR)3例(13.0%),部分缓解(partial response,PR)10例(43.5%),疾病稳定(stable disease,SD)2例(8.7%)。T-VAD治疗组总有效率66.7%(16/24),其中CR 4例(16.7%),VGPR 2例(8.3%),PR 10例(41.7%),SD 5例(20.8%),疾病进展(progressive disease,PD)3例(12.5%)。2组疗效比较差异有统计学意义(P<0.05)。PAD组的不良反应为:便秘5例(21.7%),腹泻4例(17.4%),恶心3例(13.0%);中性粒细胞减少3例(13.0%),贫血2例(8.7%),血小板下降2例(8.7%);乏力2例(8.7%);带状疱疹6例(26.1%);周围神经病变5例(21.7%)。T-VAD组患者均有便秘(100%),嗜睡15例(62.5%),皮疹2例(8.3%),带状疱疹1例(4.2%),下肢水肿2例(8.3%),深静脉血栓1例(4.2%)。2组患者均未发生严重的不良反应。结论:PAD和T-VAD方案均具有良好的安全性,而PAD方案对初治多发性骨髓瘤的疗效较好。

Objective：To study the efficacy and safety of PAD regimen（bortezomib ＋ adriamycin ＋ dexamethasone） and T-VAD regimen（vindesine ＋ adriamycin ＋ dexamethasone ＋ thalidomide） in the treatment of newly diagnosed multiple myeloma （MM）.Methods：A total of 47 patients with newly diagnosed MM were involved.Twenty-three patients were treated with PAD regimen.Twenty-four patients were treated with T-VAD regimen.Results：The overall response rate with PAD regimen was 91.3％（21/23）,with complete response（CR） in 8 cases（34.8％）,very good partial response（VGPR） in 3 cases（13.0％）,partial response（PR） in 10 cases（43.5 ％）,stable disease（SD） in 2 cases（8.7 ％）.The overall response rate with T-VAD regimen was 66.7％（16/24）,with CR in 4 cases（16.7％）,VGPR in 2 cases（8.3％）,PR in 10 cases（41.7％）,SD in 5 cases （20.8％）,progressive disease（PD） in 3 cases（12.5 ％）.There was significant difference in efficacy between the two groups（P＜0.05）.The adverse events with PAD regimen included constipation in 5 cases（21.7 ％）,diarrhea in 4 cases（17.4 ％）,nausea in 3 cases （13.0 ％）,neutropenia in 3 cases （13.0 ％）,anemia in 2 cases （8.7 ％）,thrombocytopenia in 2 cases （8.7 ％）,weak in 2 cases （8.7 ％）,herpes zoster in 6 cases（26.1％）,peripheral neuropathy in 5 cases（21.7％）.The adverse events with T-VAD regimen included constipation in 24 cases（100％）,somnolence in 15 cases（62.5％）,rash in 2 cases（8.3％）,herpes zoster in 1 case （4.2 ％）,edema of lower extremity in 2 cases（8.3 ％）,deep venous thrombosis in 1 case（4.2 ％）.No severe side effects were observed in both therapies.Conclusions：Both therapies are safe,and PAD is more effective than T-VAD regimen for patients with newly diagnosed MM.