TD方案与VAD+沙利度胺方案治疗多发性骨髓瘤临床分析

Efficacy and safety of TD and VAD + thalidomide regimens for multiple myeloma

目的评价TD方案与VAD+沙利度胺方案治疗初治多发性骨髓瘤(MM)患者的疗效及副作用。方法 68例初治MM患者根据方案不同分为TD组(32例)和VAD+沙利度胺组(36例),两种方案分别化疗4个疗程后,评估两组患者的疗效、副作用及生存时间。结果 68例患者获得完全缓解(CR)、非常好的部分缓解(VGPR)、部分缓解(PR)、稳定(SD)和疾病进展(PD)的患者在TD组为2、3、17、7、3例,VAD组为2、4、19、6、5例。其中有效患者(ORR=CR+VGPR+PR)在两组中比例分别为68.75%和69.44%,差异无统计学意义(P>0.05)。两组患者均有嗜睡、粒细胞减少、继发感染、周围神经病变等化疗相关副作用,经药物减量及对症处理后均可好转,TD组粒细胞减少、继发感染及周围神经病变发生率显著低于VAD+沙利度胺组,差异有统计学意义(P<0.05);两组患者OS及PFS差异无统计学意义(P>0.05)。结论 TD方案总体疗效与VAD+沙利度胺方案相当,可作为初治MM的有效治疗方案,但相较VAD+沙利度胺方案毒副作用更轻,患者耐受性良好。

Objective To compare the efficacy and adverse effects of thalidomide＋dexamethasone amethasone（TD）and Vindesine＋pharmorubicin＋dexamethasone amethasone ＋thalidomide （VAD ＋Thalidomide ）regimens in multiple myeloma （MM）.Methods There were 32 and 36 new diagnosed MM patients in TD and VAD＋Thai groups.Both clinical effects and adverse effects were observed after patients were accepted TD or VAD＋T Thalidomide regimens for 4 cycles.Results In TD group,there were 2,3,17,7 and 3 patients who a-chieved complete remission（CR）,very good partial remission（VGPR）,partial remission（PR）,stable disease（SD）and progressive disease （PD）,respectively;in VAD group,the number was 2,4,19,6 and 5,respectively.The rate of patients who achieved good efficacy（CR＋VG-PR＋PR）in TD group was 68.75%,while that in VAD group was 69.44%（P＆gt;0.05）.Somnolence,neutropenia,infection,peripheral neu-ropathy and other chemotherapy-related adverse effects were observed in both of the two groups,and all of the symptoms could be improved through the dose reduction and symptomatic treatment.In TD group,the incidences of neutropenia,infection and peripheral neuropathy were significantly lower than those in VAD＋thalidomide group （P〈0.05）.There was no difference in OS and PFS between the two groups（P〉0.05）.Conclusion Compared with the VAD＋thalidomide chemotherapy,TD could reach similar effect,and could be used as one of the ef-fective chemotherapy for newly diagnosed MM patients.The toxicity of TD is lighter than that of VAD＋thalidomide,and could be well tolera-ted by patients.