多发性骨髓瘤患者联合酞胺哌啶酮治疗的疗效分析

Efficacy of the combined treatment of thalidomide for patients with multiple myeloma

目的探讨低剂量酞胺哌啶酮联合VAD方案治疗多发性骨髓瘤(MM)的疗效及安全性。方法选择我院收治的MM患者53例,进行酞胺哌啶酮联合VAD方案治疗,4个疗程后进行整体评估。观察治疗前后骨髓增生情况以及骨髓瘤细胞数量,血红蛋白、β_2-微球蛋白、卡氏评分等各项检测指标的变化,分析患者的不良反应。结果 53例患者的总有效率为83.02%,治疗后患者血红蛋白、卡氏评分显著高于治疗前,差异有统计学意义(血红蛋白:t=7.465,P=0.000;卡氏评分:t=12.082,P=0.000)。骨髓浆细胞百分比、β_2-微球蛋白、肌酐、血清球蛋白显著低于治疗前,差异有统计学意义(骨髓浆细胞:t=22.747,P=0.000;β_2-微球蛋白:t=14.442,P=0.000;肌酐:t=2.928,P=0.004;血清球蛋白:t=20.894,P=0.000)。25例轻度嗜睡(47.17%)、6例头晕(11.32%)、38例便秘(71.70%)、30例四肢麻木(56.60%)。25例轻度纳差(47.17%),13例轻度恶心呕吐(24.53%),但均可耐受。结论低剂量酞胺哌啶酮联合VAD方案治疗MM疗效显著,且不良反应少、耐受性好、给药方便,值得临床推广。

Objective To investigate the efficacy and safety of the treatment of low-dose thalidomide combined with VAD regimen for patients with multiple myeloma（ M M）. Methods Fifty three patients with M M were treated by thalidomide combined with VAD regimen in our hospital. The assessment was applied after four courses. The bone marrowhyperplasia,number of myeloma cells,hemoglobin,β_2-microglobulin,Karnofsky index and other indicators were observed before and after treatment,as well as the patient＇s adverse reaction. Results The total effective rate was 83. 02% among 53 patients. The hemoglobin and Karnofsky score after treatment were significantly higher than those before treatment,the differences were significant（ hemoglobin： t = 7. 465,P = 0. 000; Karnofsky score： t =12. 082,P = 0. 000）. The percentage of bone marrowplasma cells,β_2-microglobulin,creatinine and serum globulin were significantly lower than those before treatment,the differences were significant（ bone marrowplasma cells： t =22. 747,P = 0. 000; β_2-microglobulin： t = 14. 442,P = 0. 000; creatinine： t = 2. 928,P = 0. 004; serum Globulin： t =20. 894,P = 0. 000）. There were 25 patients with mild drowsiness（ 47. 17%）,6 patients with dizziness（ 11. 32%）,38 patients with constipation（ 71. 70%）,30 patients with limbs numbness（ 56. 60%）,25 patients with mild anorexia（ 47. 17%） and 13 patients with mild nausea and vomiting（ 24. 53%）. However,all of the adverse reaction could be tolerated. Conclusion The efficacy of the treatment of low-dose thalidomide combined with VAD regimen is significant with the advantages of fewer adverse reaction,good tolerability and easy administration. It is worthy of application in clinics.