沙利度胺联合VAD方案治疗多发性骨髓瘤的疗效及对患者免疫功能的影响

The efficacy of combined therapy of thalidomide and VAD program on multiple myeloma and the effect on immune function

目的研究沙利度胺联合VAD方案治疗多发性骨髓瘤的疗效及对患者免疫功能的影响。方法选取74例多发性骨髓瘤患者,根据分层随机分组法分为观察组和对照组,每组各37例。对照组采取VAD方案进行治疗,观察组在此基础上加以沙利度胺进行治疗。分析两组患者治疗前和治疗4个周期后免疫功能、骨髓瘤细胞、β_2-微球蛋白、M蛋白、血红蛋白指标变化,比较两组患者的临床疗效和不良反应。结果治疗4个周期后,观察组的CD4+CD25+、IL-6、TGF-β指标明显低于对照组,INF-γ/IL-10指标高于对照组,差异均有统计学意义(P﹤0.05)。治疗4个周期后,观察组的骨髓瘤细胞、β2-微球蛋白、M蛋白指标明显低于对照组,血红蛋白明显高于对照组,差异均有统计学意义(P﹤0.01)。观察组总有效率高于对照组(P﹤0.05)。观察组和对照组的皮疹、感染、便秘、嗜睡等不良反应发生率比较差异无统计学意义(P﹥0.05)。结论在治疗多发性骨髓瘤中采取沙利度胺联合VAD方案能有效改善患者的免疫功能,临床疗效较好,不良反应属于轻度型,患者均可耐受。

 Objective To investigate the efficacy of combined therapy of thalidomide and VAD program on multiple myeloma （MM） and the influence on patients＇immune function. Method 74 cases of MM patients were included in the study, and were randomized as study group and control group, with 37 cases in each. The control group was given VAD program alone, while the study group was additionally treated with thalidomide on the basis of VAD. The immune func-tion, myeloma cells, β2-microglobulin, M protein and hemoglobin index changes after 4 cycles of treatment were ana-lyzed, besides, the clinical efficacy and adverse reaction were evaluated. Result After 4 cycles, the study group had low-er levels of CD4＋CD25＋, IL-6, TGF-β, but higher INF-γ/IL-10 than the control group, with statistically significant differ-ences observed （P〈0.05）. Furthermore, after 4 cycles of treatment, the myeloma cells,β2-microglobulin, M protein were all lower, while hemoglobin was higher in study group than those in the control group （P〈0.01）. Higher response rate was observed in study group compared with control group （P〈0.05）. The two groups were similar in regard of the incidences of skin rash, infection, constipation, and lethargy （P〉0.05）. Conclusion In the treatment of multiple myeloma, thalido-mide combined with VAD program can effectively improve patient＇s immune function, with better clinical efficacy, and minor adverse reactions, and is well tolerated.