T-BD方案与T-VTD方案治疗老年多发性骨髓瘤的比较

Comparison of T-BD and T-VTD regimen in treatment of senile patients with multiple myeloma

目的观察T-BD方案与T-VTD方案治疗老年多发性骨髓瘤（ MM）的有效性和安全性。方法2009年1月~2014年7月共收治86例MM患者，年龄均＆gt;60岁，根据临床使用的化疗方案不同分为T-BD组（硼替佐米＋地塞米松＋沙利度胺化疗方案）与T-VTD组（长春地辛＋吡柔比星＋地塞米松＋沙利度胺化疗方案），其中T-BD组39例，T-VTD组47例。化疗至少2个周期后，评价疗效及不良反应。结果 T-BD组总有效率为82.0%，完全缓解（ CR）＋非常好的部分缓解（ VGPR）共计10例（25.6%）；T-VTD组总有效率为59.6%，CR＋VGPR共计3例（6.4%），两组差异均有统计学意义（ P〈0.05）。主要不良反应有：血液学毒性、乏力、恶心、呕吐、便秘、心脏毒性、周围神经病变，T-BD组中性粒细胞下降和消化道症状发生率均较T-VTD组发生率低（ P〈0.05）。结论 T-BD治疗方案对于老年MM患者具有良好的疗效和安全性，而T-VTD因其价格低廉，对于经费困难的老年患者仍不失为有效治疗策略。

Objective To observe the efficiency and safety of T-BD and T-VTD regimen in the treatment of senile patients with multiple myeloma（ MM）. Methods Total 86 MM patients received treatment in our hospital from Jan. of 2009 to Jul. of 2014,and their average age were more than 60 years old. According to the different chemotherapy regimens in clinical use,they are divided into T-BD group（ bortezomib ＋ dexamethasone ＋ thalidomide chemotherapy,n = 39 ）and T-VTD group（ Changchun VDS ＋ THP ＋dexamethasone＋thalidomide chemotherapy,n=47）. After two cycles of chemotherapy at least,the efficacy and adverse reaction were evaluated. Results T-BD group had a total efficiency of 82% and 10 patients had complete response（ CR ）and very good partial response（VGPR）（25. 6%）;T-VTD group had a total efficiency of 59. 6% and total three patients had CR and VGPR（6. 4%）. The difference between the two groups was statistically significant（P〈0. 05）. The main adverse reactions included：hematologic toxicity, fatigue,nausea,vomiting,constipation,cardiac toxicity,and peripheral neuropathy;neutropenia and gastrointestinal symptoms of the patients in T-BD group were relatively lower than those in T-VTD group（P〈0. 05）. Conclusion T-BD regimen has a good efficacy and safety for senile patients with MM,and T-VTD regimen is also an effective treatment strategy for senile patients with financial difficulties because of its low price.