硼替佐米联合方案治疗多发性骨髓瘤的疗效分析

Bortezomib- based combination chemotherapy for patients with newly diagnosed multiple myeloma

目的多发性骨髓瘤（multiple myeloma,MM）是免疫系统最常见的恶性肿瘤之一,其特点是产生大量的单克隆免疫球蛋白。观察分析硼替佐米联合方案治疗、诊断MM的临床疗效及安全性。方法 35例初治多发性骨髓瘤患者均采用硼替佐米为主的联合化疗方案,所有患者分别接受2~7（中位3.3）个疗程的治疗,依据EBMT标准评估疗效反应,毒性分级按NCI-CTCAE（第3版）标准判断。结果 35例患者总反应率为82.9%,治疗后患者骨髓浆细胞比例明显减少（3.53%vs 42.19%;P〈0.01,与治疗前相比）;Ig G型与Ig A型MM患者血清中的免疫球蛋白水平较治疗前明显下降,分别由（67.23±34.04）g/L、（52.23±25.01）g/L降至（21.95±15.82）g/L、（11.49±15.79）g/L,差异有统计学意义（P〈0.01）。较常见的不良反应是血液学毒性（46%）、乏力（46%）、周围神经病变（40%）以及感染（29%）。结论硼替佐米联合方案对初诊MM患者疗效好,耐受性尚可,且不良反应程度轻微。

Multiple myeloma （MM） is one of the most common malignant tumor in immune system, which characterized by the production of large amounts of monoclonal immunoglobulins. This study performed to assess the efficacy and tolerability of bortezomib-based combination chemotherapy in treating newly diagnosed MM. Total of 35 patients diagnosed with MM and treated with bortezomib-based combination chemotherapy were recruited in the study. During the median 3.3 cycles （range： 2-7） of treatment, 29（82.9%） patients achieved at least partial response （PR） according to EBMT; the percentage of plasmacytes were significantly reduced compared with before treatment （3.53% vs 42.19%, P〈0.01）; and the immune globulin levels of IgG and IgA decreased from 67.23 g/L and 52.23 g/L to 21.95 g/L and 11.49 g/L, respectively （P〈0.01, vs before treatment）. Then we evaluated the adverse effects according to NCI-CTCAE 3.0 and found that the common adverse events were hematology toxicity （46%）, fatigue （46%）, peripheral neuropathy （40%） and infection （29%）. In conclusion, bortezomib-based combination chemotherapy demonstrates high efficacy, favorable tolerability and mild adverse effects in the treatment of newly diagnosed MM.