硼替佐米联合不同化疗药物治疗多发性骨髓瘤疗效和安全性的Meta分析

Effectiveness and safety of bortezomib combined with different chemotherapeutics for treating multiple myeloma: A Meta-analysis

目的:评价硼替佐米联合不同化疗药物治疗多发性骨髓瘤的疗效与安全性。方法:计算机检索Pub Med数据库,Cochrane图书馆临床对照试验数据库,中国期刊全文数据库和中国生物医学文献数据库,进一步对纳入文献的参考文献进行扩大搜索。采用Rev Man 5.3软件进行Meta分析。结果:共纳入8篇文献,包括1 627例患者。Meta分析显示硼替佐米联合地塞米松和沙利度胺(BTD)组较硼替佐米联合地塞米松(BD)组缓解率好[OR=1.70,95%CI(1.18,2.44),P=0.005],感染率[OR=1.19,95%CI(0.73,1.94),P=0.48]和3-4级血小板减少率[OR=2.17,95%CI(0.91,5.19),P=0.08]无统计学差异。硼替佐米联合地塞米松和阿霉素(BAD)组较BD组缓解率高[OR=3.79,95%CI(1.28,11.22),P=0.01]。BTD组和硼替佐米联合马法兰和泼尼松(BMP)组缓解率无统计学差异[OR=1.42,95%CI(0.96,2.09),P=0.08]。3-4级不良事件发生率无统计学差异[OR=1.55,95%CI(0.61,3.90),P=0.35]。BAD组和硼替佐米联合地塞米松和环磷酰胺(BCD)组缓解率无统计学差异[OR=0.99,95%CI(0.61,1.59),P=0.96],BCD组疗效好于BAD组。结论:硼替佐米三药联合较硼替佐米二药联合效果好,毒副反应基本相同。不同的三药联合方案效果也不同,在BTD、BAD、BCD、BMP这几个方案中,BCD效果最好。

Objective To assess the effectiveness and safety of bortezomib combined with different chemotherapeu- tics for treating multiple myeloma. Methods ： Data were searched from P ubM ed, Cochrane central Register of Con-trolled Trials（ CENTRAL） of The Cochrane Library China National Knowledge Infrastructure（ CNKI） and China Biol-ogy Medicine（ CBM） . Data analysis was performed with RevMan 5.3. Results： A total of 8 articles in volvin g 1 627 pa-tients were included. Meta - analysis results showed BTD was better than BD about OR[ OR = 1.80,95% CI（ 1.25 ,2. 61） yP = 0. 002] ,and the infection rate[ OR = 1. 19 ,95% CI （ 0. 73,1.94 ） yP = 0 . 48 ] and 3 and 4 grade thrombo-cytopenia [ OR = 2.17,95 % Cl （0. 91,5.19）,P=0. 08] had no significant differences. BAD was better than BD about OR[ OR = 3. 79,95% CI（ 1.28,11.22） = 0. 01 ]. BTD and BMP had no significant differences about OR [ OR =1.42,95% Cl（0. 96,2. 09） = 0. 08 ] and 3 and 4 grade adverse events had no significant differences[ OR = 1.55 ,95% CI（0. 61,3.90） ,P = 0. 35 ]. BCD and BAD had no significant differences about OR[ OR = 0. 99 ,95% Cl （0. 61,1.59） ,P =0.96] ,but BCD has better effect than BAD. Conclusion： Bortezomib plus two drugs is better than borte-zomib plus one drugs and the side effect had no significant differences. The different plan about bortezomib plus two drugs have different effect,BCD is the best about BTD,BAD,BCD,BMP.