TD方案治疗多发性骨髓瘤临床分析

Clinical analysis on TD therapeutic regimen in treatment of multiple myeloma

目的：探讨沙利度胺联合地塞米松方案（TD方案）治疗多发性骨髓瘤（MM）的临床疗效及不良反应。方法35例MM患者随机分为TD方案组（A组）15例， VAD方案组（B组）10例，TVAD方案组（C组）10例。沙利度胺起始剂量100 mg/d ，d 1～d 28，地塞米松40 mg/d静脉滴注，d 1～d4；长春新碱0．5 mg/d静脉滴注，d 1～d 4，阿霉素10 mg/d静脉滴注d 1～d 4，28 d 1疗程，连续3个疗程后评价疗效及不良反应。结果部分缓解率A组、B组、C组分别为46．7％、50．0％、50．0％；总有效率分别为80．0％、80．0％、90．0％，差异无统计学意义（P值均大于0.05）。3组不良反应发生率：骨髓抑制分别为20．0％、40．0％、40．0％；心脏损害分别为0．0％、20．0％、20．0％；周围神经病变分别为20．0％、40．0％、50．0％；感染分别为6．67％、30．0％、30．0％，差异均有显著性（ P值均小于0．05）。结论 TD方案治疗MM有较高的缓解率且不良反应发生率最小。

Objective To evaluate the curative effect and side effect of thalidomide in combination with dexamethasone （TD） or VAD or T-VAD in treatment of multiple myeloma（MM）.Methods 35 cases of MM were randomly divided into a TD group （group A,15 cases）,a VAD group（group B,10 cases）,and a T-VAD group （group C,10 cases）,respectively.The beginning dose of thalidomide was 100mg/d,dexamethasone was 40mg/d,d1~4,doxorubicin was 10mg/d,d1~4,vincristine was 0.4mg/d,d1~4.Therapeutic effect and side effect were evaluated after three continuous treatment courses .Results The partial remission rates of groups A , B and C were respectively 46.7%,50.0% and 50.0%.The total efficacy rates were 80.0%,80.0%and 90.0%,respectively.The difference was not significant（P＆gt;0.05）.As for the incidence of adverse reac-tion,there were significant differences among the three therapeutic regimen groups （P＆lt;0.05）.The arrests of bone marrow were respectively 20.0%,40.0%and 40.0%;the heart injures 0.0%,20.0% and 20.0%;the peripheral neuropathies 20.0%, 40.0%and 50.0%;the infections 6.67%,30.0%and 30.0%respectively.Conclusion TD therapeutic regimen has a high-er remission rate and a lower rate of adverse reaction in the treatment of MM .