改良PAD方案治疗初发多发性骨髓瘤的疗效及安全性

Efficacy and safety of modified PAD regimen in the treatment of primary multiple myeloma

目的:探讨不同硼替佐米剂量的PAD方案(硼替佐米+表阿霉素+地塞米松)治疗多发性骨髓瘤(multiple myeloma,MM)的疗效和安全性。方法:回顾性分析PAD方案治疗的32例MM患者的临床资料。其中,硼替佐米1.3mg/m^2静脉注射(d 1、d 4、d 8、d 11)+表阿霉素20mg静脉滴注(d 1~4)+地塞米松20mg静脉滴注(d 1~4、d 8~11)治疗20例(PAD 1组);硼替佐米1.6mg/m^2静脉注射(d 1、d 8、d 15)+表阿霉素20mg静脉滴注(d 1、d 8、d 15)+地塞米松20mg静脉滴注(d 1~2、d 8~9、d 15~16)治疗12例(PAD 2组)。两组均以28d为1个疗程,化疗3~6疗程。比较两组MM患者完成3个疗程后的疗效与不良反应。结果:PAD 1组总有效率为80.0%,PAD 2组为83.3%,两组差异无统计学意义。PAD 1组带状疱疹(30.0%vs 0%)患者多于PAD 2组,差异有统计学意义(P<0.05);PAD 1组与PAD 2组胃肠道反应(20.0%vs16.7%)、周围神经炎(25.0%vs 16.7%)、粒细胞减少(15.0%vs 16.0%)、血小板减少(10.0%vs 8.0%)患者差异无统计学意义。结论:硼替佐米1.6mg/m^2每周1次静脉注射的PAD方案治疗与硼替佐米1.3mg/m^2每周2次静脉注射的PAD方案疗效相似,且硼替佐米1.6mg/m^2每周1次静脉注射的PAD方案不良反应更少,更为安全。

Objective ： T o observe th e efficacy and safety of tw o P A D regim ens w ith d ifferent doses of bortezom ib（bortezom ib ＋ E p irubicin ＋dexam ethasone） in the treatm en t of patients w ith m ultiple m yelom a （M M ）. Methods： T h eclinical data of 32 MM patients treated w ith P A D regim ens w ere retrosp ectively analyzed. T h e doses of intravenous bortezom ibw ere different in tw o P A D regim ens. P atien ts in group P A D 1 （n = 2 0 ） received bortezom ib 1. 3 mg/m2 through intravenousinjection on d 1 , d 4 , d 8 , and d 1 1 , epirubicin 20 mg through intravenous infusion on d 1 to d 4 , and dexam ethasone 20 mgthrough intravenous infusion d 1 to d 4 , and d 8 to d 11. P atien ts in group P A D 2 （ w = 1 2 ） received bortezom ib 1. 6 mg/m2through intravenous injection on d 1 , d 8 , and d 1 5 , epirubicin 20 m g through intravenous infusion on d 1 , d 8 , and d 1 5 , anddexam ethasone 20 m g through intravenous infusion on d 1 - 2 , d 8 - 9 , and d 15-16. A ll patients received 3 to 6 courses oftreatm en t and each course lasted for 28 days. Clinical efficacy and adverse reactions of two groups of MM patients w erecompared a fte r the com pletion of 3 courses. Results： A fte r the first three courses？ The effective rate of group P A D 1 was80. 0 % , the effective rate of group P A D 2 w as 83. 3 % ？ And there w as no significant d ifference betw een the tw o groups. T h e rew ere m ore herpes zoster patients in group P A D 1 than group P A D 2 （ 3 0 % vs 0 % ） ？ And the difference was statisticallysignificant （P 〈 C 〇. 0 5 ） . T h e re w ere no statistical differences in the incidence of gastroin testin al reaction , peripheral n eu ritis,granulocytopenia, and throm bocytopenia betw een the tw o groups （2 0 . 0 % vs 16. 7 % , 25. 0 % w 16. 7 % ,15. 0 % vs IQ. 0 % ,and 10. 0 % vs 8. 0 % , P y 〉 0 . 0 5 ）. Conclusions： T h e P A D regim en w ith intravenous injection of bortezom ib 1. 6 mg/m2 once aw eek is sim ilar to th e P A D regim en w ith intravenous injection of bortezom ib 1. 3 mg/m2 tw ice a w eek in efficacy , but it is saferw ith less adverse reactions.