VAD、改良M_2和MP方案联合沙利度胺治疗多发性骨髓瘤的疗效观察及对比研究

Curative effect observation and contrastive study of VAD,improved M_2 and MP program combined with thalidomide in treatment of multiple myeloma

目的评价VAD、改良M_2和MP化疗方案联合沙利度胺治疗多发性骨髓瘤的疗效。方法 39例MM患者根据患者病情、经济情况及意愿分为3组:VAD治疗组26例,初治者20例,使用改良M_2或MP方案者(含马法兰化疗方案)21例,初治患13例;其中使用过改良M_2治疗组有14例:初治者4例,复治者10例;使用过MP治疗组有15例,初治者10例,复治者5例。MP和M_2方案重复使用者8例。先后VAD和改良M_2或MP方案重复使用者8例。结果 VAD组和含马法兰(M)组初治患者总有效(OR)(≥PR)率分别为80.0%和76.9%(P>0.05),≥VGPR率:分别为60.0%和46.2%(P>0.05)。初治+复治者总有效(OR)(≥PR)率分别为76.9%(26例VAD组)和57.1%(21例含M组)(P>0.05),≥VGPR率分别为53.8%和42.9%(P>0.05)。其中10例MP方案初治者4例达VGCR以上疗效,4例改良M_2初治患者3例达VGCR以上疗效,3例使用VAD方案初治者效果不佳,后改用M_2方案达缓解(VGPR以上疗效)。VAD组和含M方案总生存(OS)时间:初治患者分别为39个月和25个月(P>0.05);初治和复治患者总体统计分别为39个月和50个月(P>0.05)。VAD组和含M方案无进展生存(PFS)时间:初治患者分别为31个月和18个月(P>0.05);初治和复治患者总体统计分别为29个月和31个月(P>0.05)。结论 VAD、改良M_2和MP方案联合沙利度胺化疗方案仍为个体化治疗老年MM患者的经济、有效的方案。

[Abstract] Objective To evaluate the curative effect of VAD,improved M2 and MP program combined with thalidomide in treatment of multiple myeloma （MM）. Methods According to the patient＇ s condition,economic situation and individual wi11,39 cases of patents with MM were divided into three groups.26 patients were treated with VAD,which included 20 cases with newly diagnosed MM,21 patients were treated with improved M2 and MP program （Chemotherapy regimens including melphalan）,which included 13 cases with newly diagnosed newly diagnosed MM.14 patients were treated with improved Mvwhich included 4 cases with newly diagnosed MM and 10 cases with recurrently diagnosed MM.15 patients were treated with MP,which included 10 cases with newly diagnosed MM and 5 cases with recurrently diagnosed MM.8 patients were treated with MP and M2 program repetition.8 patients were treated with successively VAD and improved M2 or MP program repetition. Results The total effective rate of VAD group and Melphalan （M） group （OR）（ ≥PR） respectively were 80% and 76.9% （P 〉 0.05）.The total effective rate of patients with newly diagnosed MM of VAD group and Melphalan （M） group （OR）（ ≥GPR） respectively were 60.0% and 46.2% （P〉0.05）.The total effective rate of patients with newly and recurrently diagnosed MM of VAD group and Melphalan （M） group （OR）（ 1〉 PR） respectively were 76.9% （26 cases in VAD group） and 57.1% （21 cases in M group） （P 〉 0.05）.The total effective rate of patients with newly diagnosed MM of VAD group and Melphatan （M） group （OR）（ ≥ VGPR） respectively were 53.8% and 42.9% （P 〉 O.05）.There are 4 cases of VGCR or more curative effect among the 10 cases of newly diagnosed MP.There are 3cases of VGCR or more curative effect among the 4 cases of newly diagnosed improved M2.The effect of 3 cases of patients with newly diagnosed VAD was poor.After switching to M2 program, it was up to VGPR efficacy.Overall survival （OS） time of VAD group and M group respectively were 39 months and 25 months for patients with new diagnosis （P〉0.05）,39 months and 50 months for patients with new and recurrent diagnosis （P 〉 0.05）.Progression free survival （PFS） time of VAD group and M group respectively were 31 months and 18 months for patients with new diagnosis （P 〉 0.05）,29 months and 31 months for patients with new and recurrent diagnosis （P 〉 0.05）. Conclusion VAD,improved M2 and MP program combined with thalidomide chemotherapy is an economical and effective solution to individually doctor elderly patients with MM.