CTD方案与TD方案对初治多发性骨髓瘤的疗效对比

Comparison of Efficacy of CTD Combined with TD for Newly Diagnosed Multiple Myeloma

目的分析应用环磷酰胺、沙利度胺和地塞米松(CTD)联合化疗方案与沙利度胺联合地塞米松(TD)方案治疗多发性骨髓瘤(MM)的效果差异,为骨髓瘤的治疗提供更加有效的治疗方法。方法选取多发性骨髓瘤患者30例,随机分为2组,观察组的15例患者采用CTD方案进行治疗,对照组的15例患者采用TD方案进行治疗。接受6个疗程的治疗后分析观察组和对照组治疗有效率、不良反应发生情况及生存时间。结果观察组15例患者中有13例得到不同程度的缓解,其中完全缓解(CR)4例,部分缓解(PR)6例,病情稳定(SD)1例,病情进展(PD)1例,严格的完全缓解(s CR)1例,总有效率(RR)为86.67%;对照组有9例患者得到不同程度的缓解,其中CR 1例,PR 4例,SD 3例,PD 1例,总有效率为60.00%(8/15),与观察组比较差异具有统计学意义(P<0.05)。治疗后观察组血红蛋白增长值、血β2微球蛋白下降值及血浆中骨髓细胞比例下降值与对照组比较,差异具有统计学意义(P<0.05)。随访2~48个月,中位随访时间为24个月,观察组患者存活13例,生存率为86.67%,平均生存时间25个月;TD组患者存活8例,生存率为53.33%,平均生存时间为16个月,两组患者生存率及平均生存时间比较差异具有统计学意义(P<0.05)。观察组中常见不良反应如乏力、皮疹、头晕及白细胞减少等发生率较对照组明显降低,差异具有统计学意义(P<0.05)。结论 CTD联合化疗方案在多发性骨髓瘤的治疗中疗效比TD方案更加显著,患者的生存率得到了显著提高,CTD联合化疗方案优于TD方案。

Objective To compare the efficacy of cyclophosphamide, thalidomide and dexamethasone （CTD） regimen combined with thalidomide and dexamethasone （TD） regimen for newly diagnosed multiple myeloma, and to provide more effec- tive treatment method for multiple myeloma. Methods 30 cases of multiple myeloma patients were randomly divided into 2 groups, 15 patients in the observation group were treated with CTD, and 15 patients in the control group were treated with TD. Af- ter 6 courses of treatment, efficiency, adverse reaction and survival time of the treatment group and the control group were ana- lyzed. Results In the observation group, 13 cases were alleviated and the complete remission （CR）was 4 cases, partial remission （PR） 6 cases,stable disease （SD） 1 case,1 case of disease progression （PD） ,complete response （sCR） 1 case,the total efficiency （RR） was 86.67% ;9 cases in control group were alleviated, CR 1 cases,PR 4 cases, SD 3 cases, PD 1 cases,the total effective rate was 60% （8/15） ,and compared with the observation group, the difference was statistically significant （P 〈 0.05 ）. After treatment, there had significant difference （ P 〈 0.05 ） in the hemoglobin growth value, the decrease of serum beta 2 micro- spheres protein and the proportion of plasma in the proportion of bone marrow cells decreased compared between the 2 groups. The follow-up was 2 -48 months ,the median follow-up time was 24 months, 13 cases in the observation group survived, the survival rate was 86.67%, the average survival time was 25 months;8 cases in TD group survived, the survival rate was 53.33 %, the aver- age survival time was 16 months ,there had statistical difference in survival rate and mean survival time between the 2 groups （P 〈 0.05）. The incidence of common adverse reactions such as fatigue, rash, dizziness and white blood cells in the observation group was significantly lower than that of the control group, and the difference was statistically significant （ P 〈 0.05 ）. Conclusion CTD combined with chemotherapy in the treatment of multiple myeloma is more significant than the TD regimen, the survival rate of patients has been significantly improved, CTD combined chemotherapy is better than the TD program.