改良硼替佐米、地塞米松及环磷酰胺方案治疗多发性骨髓瘤的临床效果分析

Improvement on Dexamethasone, Bortezomib and Cyclophosphamide for the Treatment of Multiple Myeloma

目的:探析改良硼替佐米、地塞米松及环磷酰胺方案治疗多发性骨髓瘤的治疗效果和安全性,旨在为今后多发性骨髓瘤化疗方案的选择提供新的思路。方法:回顾性分析2013年2月—2016年2月期间在血液科和肿瘤科收治的多发性骨髓瘤患者的临床资料,均给予改良硼替佐米、地塞米松、环磷酰胺方案治疗,分析临床治疗效果、不良反应、随访生存情况。结果:36例患者完成中位3(1~6)个疗程化疗,总有效率(Overall response rate,ORR)为55.56%;接受2个疗程化疗的30例患者总有效率达83.33%(25/30);接受4个疗程的16例中,完全缓解率(Complete remission,CR)25.00%(4/16)、肿瘤血管生成率(Vascular endothelial growth factor receptor,VGFR)62.50%(10/16),总有效率达100.00%;初治者总有效率为91.67%明显高于复发/难治者的总有效率37.50%(χ~2=9.5063,P=0.0020)。不良反应主要包括白细胞下降、血小板计数下降、1~2级周围神经病变、消化系统不良反应、感染、转氨酶升高等。中位随访时间为8.6(1~28)月;初治者总生存率为83.33%明显高于复发/难治者的总生存率45.83%(11/24)(χ~2=4.6286,P=0.0314)。结论:改良硼替佐米、地塞米松、环磷酰胺方案治疗多发性骨髓瘤疗效显著,不良反应少且轻微,初治者疗效明显优于复发/难治者,患者耐受性好,4个疗程内疗效递增,可在临床中广泛应用。

Objective： Analysis of the therapeutic effect and safety on modi？ed bortezomib, dexamethasone and cyclophosphamide for treatment of multiple myeloma, in order to provide new ideas for future multiple myeloma tumor chemotherapy. Methods： A retrospective analysis of clinical data of February 2013-February 2016 in the Department of Hematology and Oncology from multiple myeloma patients treated with modi？ed for bortezomib, dexamethasone and cyclophosphamide regimen was performed, and the clinical therapeutic effect, adverse reaction and follow-up survival were compared. Results： 36 patients completed a 3 （1～6） courses of chemotherapy, the total response rate （ORR） was 55.56%. 30 patients who received two treatment with total effective rate of 83.33% （25/30）; 16 patients who received four course with CR rate of 25.00% （4/16）, VGFR rate 62.50%（10/16）.The total effective rate was 100.00%; total ef？ciency of the patients as the ？rst treatment was 91.67% , which was signi？cantly higher than that in relapsed/refractory patient with a total ef？ciency of 37.50%（χ2=9.5063,P=0.0020）. Adverse reactions include the decrease of white blood cells, decreased platelet count, grade 1 peripheral neuropathy, digestive side effects, infection, and increased transaminases. The median follow-up time was 8.6 months （1～28）; at the beginning of the treatment the total survival rate was 83.33%, which was signi？cantly higher than relapsed/refractory total survival rate of 45.83% （11/24） （χ2=4.6286,P=0.0314）. Conclusion： Modi？ed bortezomib, dexamethasone and cyclophosphamide treatment for multiple myeloma showed signi？cant effect, with mild adverse reactions. Initial treatment curative effect is obviously better than that of relapse/refractory, thus it is worth of widely use in clinical.