含硼替佐米的BDT、BCD、BAD化疗方案治疗初诊性多发性骨髓瘤

Contained-bortezomib BDT,BCD or BAD chemotherapy for newly diagnosed multiple myeloma

目的研究分析硼替佐米为主的联合化疗方案BDT、BCD、BAD治疗初诊性多发性骨髓瘤的整体临床效果及不良反应。方法回顾性分析笔者所在医院2011年1月—2015年6月收治的初诊性多发性骨髓瘤患者210例,分别行BDT方案化疗(B1组)92例,BCD方案化疗(B2组)89例,BAD方案化疗(B3组)29例。结果联合化疗方案中,B1组治疗后有效率为80.43%,B2组治疗后有效率为86.52%,B3组治疗后有效率为93.11%,三组比较,B3组治疗后有效率略高于B2组和B1组的治疗后有效率(P=0.0145);B2组治疗后有效率略高于B1组(P=0.0386);化疗后各组的不良反应发生情况比较,粒细胞降低中B1组发生率小于B2组(P=0.0392),B2组小于B3组(P=0.117);血小板降低中,B2组发生率明显高于B3组(P=0.046),B3组发生率明显高于B1组(P=0.029);疲乏患者中,B3组发生率明显高于B2组(P=0.028),而B2组与B1组间无显著差异(P=0.938);病毒疱疹中,B1组发生率明显高于B2组(P=0.006)和B3组(P=0.018),而B3组发生率明显高于B2组(P=0.033),比较差异具有统计学意义;贫血、感染、腹泻、腹水并发症发生情况中,三组间无显著差异,比较无统计学意义(P>0.05)。结论以硼替佐米(万珂)为主的联合化疗方案BDT、BCD、BAD治疗初诊多发性骨髓瘤均可取得较好的临床疗效,尤其以BAD的联合用药有效率最高。但是由于该研究的病例尚数量不足,何种方案最优还需进一步研究,对于临床医师的选择应用还需其根据患者的具体情况进行制定。

Objective To investigate the overall clinical efficacy and adverse reaction of BDT,BCD or BAD combination chemotherapy based on bortezomib for patients with newly diagnosed multiple myeloma. Methods The 210 patients with newly diagnosed multiple myeloma treated in author＇s hospital from January 2011 to June2015 were retrospectively analyzed. Among them,92 cases received BDT chemotherapy（B1 group）,89 cases received BCD chemotherapy（B2 group） and 20 cases received BAD chemotherapy（B3 group）. Results In combination chemotherapy,the effective rate after treatment was 80.43% in B1 group,86.52% in B2 group and93.11% in B3 group respectively. Among these three groups,the effective rate after treatment was slightly higher in B3 group than that of B2 and B1 group（P=0.0145）;In addition,the effective rate after treatment was slightly higher in B2 group than that of B1 group（P=0.0392）;Through comparing incidences of adverse effects in different groups,the incidence of reducing granulocyte in B1 group was lower than that of B2 group（P =0.0392） and B2 group was lower than B3 group（P =0.117）;There was significantly higher incidence of reducing platelet in B2 group than that of B3 group（P=0.046）,and B3 group was significantly higher than B1 group（P=0.029）;B3 group had higher incidence of fatigue than that of B2 group（P =0.028）,however,there was no significant difference between B2 and B1 group（P=0.938）;The incidence of herpes was significantly higher in B1 group than that of B2group（P=0.006） and B3 group（P=0.018）,and B3 group was significantly higher than B2 group（P =0.033）,with a statistically significant difference. There were no significant differences in the incidence of complications such as anemia,infection,diarrhea and ascites between three groups,without a statistically significant difference（P〉0.05）.Conclusions All the BDT,BCD or BAD combination chemotherapy based on bortezomib for patients with newly diagnosed multiple myeloma can achieve good clinical efficacy,among them,BAD is especially the most effective therapy. However,as for the limited number of cases included in this study,further studies are needed to decide which therapy is the best. Thus,for practical choice in clinic,it should be based on specific conditions.