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PAD方案治疗初治多发性骨髓瘤的临床疗效 被引量:9

Clinical efficacy of PAD chemotherapy in patients with newly diagnosed multiple myeloma
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摘要 目的:评估PAD方案(硼替佐米+脂质体多柔比星+地塞米松)治疗初治多发性骨髓瘤(MM)的疗效和安全性。方法:初治MM 27例,均给予PAD方案为一线治疗:硼替佐米1.3mg/m2,静脉注射,第1、4、8、11天;脂质体多柔比星20mg,静脉滴注,第1、4、8天;地塞米松20~40mg/d,静脉滴注,第1、4、8、11天;每28d为1个周期。27例患者接受平均4(2~8)个疗程的治疗。观察其短期疗效和长期疗效,并判断其不良反应。结果:近期疗效观察:初始疗效的中位时间为2周,最佳疗效的中位时间为3个月。总反应率为89%,其中完全缓解14例(52%),非常好的部分缓解2例(7%),部分缓解8例(30%)。此外,疾病稳定3例(11%),疾病控制100%。长期疗效观察:中位随访49(7~96)个月,中位无进展生存时间24个月,中位生存时间50个月。患者3年、5年、7年的无疾病进展率分别为37.0%、17.3%和8.6%,3年、5年、7年的总生存率分别为51.9%、47.9%和47.9%。主要的不良反应为血液学毒性,中性粒细胞减少8例(30%),贫血5例(19%),血小板减少7例(26%)。非血液学毒性主要为胃肠道症状,便秘10例(37%),腹泻、恶心、黏膜炎分别为2例(7%);其次为周围神经病变,1/2级7例(26%),3级2例(7%)。4例(15%)出现手足综合征,4例(15%)出现乏力,2例(7%)肝功能异常,2例(7%)并发带状疱疹。结论:PAD方案对于初治MM总反应率高,起效快,不良反应较小,是一种安全、有效的治疗方法。其长期疗效显示,PAD方案能使MM获得最大程度的缓解,适当的维持治疗后近半数患者长期生存。 Objective:To evaluate the efficacy and safety induced by PAD (bortezomib + pegylated liposomal doxorubicin + dexamethasone) regimen in patients with newly diagnosed multiple myeloma (MM). Method: Twenty-seven patients with newly diagnosed MM were treated with PAD regimen as first line therapy: bortezomib 1.3 mg/m^2 intravenous injection on day 1,4,8,11 ;pegylated liposomal doxorubicin 20 mg intravenously on day 1, 4,8;dexamethasone 20 to 40 mg intravenously on day 1,4,8,11. The chemotherapy was repeated every 28 days as a course. The patients were applied 4(2 to 8) courses of treatment. The short-term efficacy,long-term efficacy and the toxicity of PAD regimen were analyzed. Result: The median time to initial response was 2 weeks and the median time to best response was 3 months. The overall clinical response was observed in 89 ~ patients,including complete response in 14(52%) patients,very good partial response in 2(7%) patients,partial response in 8(30%) patients, and stable disease in 3 (11%) patients. The disease control rate was 100%. After 49 (7 to 96) months of median follow-up,the median time of progression-free survival (PFS) was 24 months, and the median survival was 50 months. The 3-year, 5-year and 7-year PFS was 37.0 %, 17.3% and 8.6 %, respectively. And the 3-year, 5-year and 7-year overall survival was 51.9 %, 47.9% and 47.9%, respectively. The major adverse events were hematologic toxicity,including neutropenia (8 patients, 30 % ), anemia ( 5 patients, 19 %) and thrombocytopenia ( 7 patients, 26%). The most common non-hematologic toxicity were gastrointestinal symptoms, including constipation in 10 (37 % ) patients, diarrhea in 2 (7% ) patients, nausea in 2 (7%) patients and mucositis in 2 (7%) patients. Other non-hematologic toxicity were peripheral neuropathy [grade 1/2 in 7 (26%) patients and grade 3 in 2 (7%) patients], hand-foot syndrome in 4 (15%) patients, fatigue in 4 (15 0%) patients, liver function abnormal in 2 (7% ) patients,and herpes zoster in 2 (7 %) patients. Conclusion:PAD scheme is an effective therapy with a high response rate and manageable toxicities for patients with newly diagnosed MM. PAD can achieve utmost remission, nearlyhalf of the patients remain long-term survival after suitable maintenance.
出处 《临床血液学杂志》 CAS 2017年第2期210-213,共4页 Journal of Clinical Hematology
关键词 多发性骨髓瘤 初治 硼替佐米 疗效 安全性 multiple myeloma newly diagnosed bortezomib efficacy safety
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