三氧化二砷联合沙利度胺治疗老年复发性多发性骨髓瘤的临床研究

Clinical Research of Arsenic Trioxide Combined with Thalidomide in the Treatment of Senile Recurrent Multiple Myeloma

目的：观察三氧化二砷联合沙利度胺治疗老年性复发性多发性骨髓瘤的临床效果及有效性和安全性,并探讨其治疗老年性复发性多发性骨髓瘤的最有效机制。方法：对13例初治和12例60岁以上老年性复发性多发性骨髓瘤患者进行临床观察,均采用三氧化二砷联合沙利度胺进行治疗,其中三氧化二砷进行10 mg/d的静脉注射,持续注射28 d,与此同时,口服小剂量沙利度胺100-200 mg/d,根据患者的实际情况可适量增加,最大限量为300 mg/d,以28 d为一疗程,服用两个疗程,期间观察疗效及副作用,按照EBMT疗效标准评价疗效,根据NCI-CTCAE标准评价不良反应。结果：在13例初治患者中,部分缓解5例（38.46%）,进步5例（38.46%）,无效3例（23.08%）,治疗总有效率为76.92%。在12例复发患者中,部分缓解4例（33.33%）,进步5例（41.67%）,无效3例（25.00%）,治疗总有效率为75.00%。初治组与多发组的治疗总有效率比较差异无统计学意义（P〉0.05）,而25例患者治疗后的平均血清M蛋白含量、血红蛋白浓度及骨髓浆细胞比例较治疗前均明显增加,差异均有统计学意义（P〈0.01）。治疗中常见不良反应有恶心乏力、腹胀便秘、皮疹、肝损伤、中性粒细胞减少等,但经过治疗均有所改善。结论：三氧化二砷联合沙利度胺对治疗老年性复发性多发性骨髓瘤安全有效,值得临床推广。

Objective：To observe the effect,validity and security of Arsenic Trioxide combined with Thalidomide in the treatment of senile recurrent multiple myeloma,and to investigate its most effective mechanism in the treatment of senile multiple myeloma.Method：The clinical data of 13 cases of initial treatment and 12 patients above 60 years of age with recurrent elderly myeloma were retrospectively analyzed,they were treated with Arsenic Trioxide combined with Thalidomide,which Arsenic Trioxide was performed with 10 mg/d intravenously,continuous injection for 28 days,at the same time,a small dose of thalidomide was given orally 100-200 mg/d,according to the actual situation of patients could be increased,the maximum limit was 300 mg/d,28 days for a course of treatment,two courses of treatment was taken,the efficacy and side effects were observed during the evaluation of curative effect,in accordance with the standard EBMT effect,according to the NCI-CTCAE（National Cancer Institute Common Terminology Criteria for Adverse Events,version 3.0） standard,the adverse reaction was evaluated.Result：In 13 patients with initial treatment,5 cases of partial remission（38.46%）,5 cases of progress（38.46%）,and 3 cases of ineffective（23.08%）,the total effective rate was 76.92%.In 12 patients with recurrence,4 cases of partial remission（33.33%）,5 cases of progress（41.67%）,3 cases of ineffective（25.00%）,the total effective rate was 75.00%.There was no significant difference in the total effective rate between the initial treatment group and the multiple group（P〉0.05）.The average serum M protein content,hemoglobin concentration and bone marrow plasma cell proportion of 25 patients after treatment were significantly increased compared with before treatment,the differences were statistically significant（P〈0.01）.Common adverse reactions in the treatment were nausea,fatigue,abdominal distension and constipation,skin rash,liver damage and the reduction of neutrophils,but after treatment had improved.Conclusion：Arsenic Trioxide combined with Thalidomide in the treatment of senile recurrent multiple myeloma is safe and effective,is worthy of clinical promotion.