三氧化二砷联合低剂量沙利度胺治疗老年性多发性骨髓瘤临床观察

Clinical study of arsenic trioxide combined with low dose thalidomide in elderly patients with multiple myeloma

目的探讨三氧化二砷联合低剂量沙利度胺治疗老年性多发性骨髓瘤临床疗效及其安全性。方法对14例初治和12例难治复发老年性（年龄〉65岁）多发性骨髓瘤患者,采用三氧化二砷联合小剂量沙利度胺方法治疗,其中三氧化二砷10 mg/d静脉滴注,共28 d,同时口服低剂量沙利度胺100~200 mg/d,2个疗程。根据EBMT疗效标准评价疗效,按NCI-CTCAE（第3版）标准评价不良反应。结果 14例初治患者中部分缓解（PR）6例（42.85%）,进步5例（35.71%）,无效3例（21.42%）,12例难治复发患者中部分缓解（PR）4例（33.3%）,进步5例（41%）,无效3例（25%）,总有效率（ORR）76.92%。最常见的不良反应为乏力、恶心、腹胀、便秘、肝损害、皮疹、中性粒细胞减少等经相应处理好转。结论三氧化二砷联合小剂量沙利度胺治疗老年性初治和难治复发性多发性骨髓瘤安全有效。

[ Objective ] To evaluate the efficacy and safety of arsenic trioxide combined with low dose thalido- mide in treating multiple myeloma （MM） patients. [Methods] 14 patients with newly diagnosed MM and 12 patients with relapsed or refractory MM were treated with arsenic trioxide combined with low dose thalidomide, arsenic triox- ide was administered 10 mg/d, 1-28 d, while thalidomide was given to those patients in the low dose 100-200 mg/d. The patients received 2 cycles of the treatment. Response was evaluated according to the EBMT criteria and adverse events were graded according to the NCI-CTCAE （version 3.0）. [Results] Out of 14 patients with newly diagnosed MM, six achieved partial remission（PR）, five achieved partial improving, three had no effects. Among the 12 patients with refractory/relapsed MM, 4 of them achieved PR, 5 of them achieved partial improving, 3 of them had no effects. The overall response rate was 76.92%. The most adverse events observed were fatigue, nausea, abdominal distention, constipation and patic lesion, etc. [ Conclusions ] Arsenic trioxide combined with low dose thalidomide is a effective treatment for elderly MM patients, and the side effects from treatment are manageable and acceptable.