异环磷酰胺、多柔比星脂质体、地塞米松联合方案对复发/难治多发性骨髓瘤有无髓外浆细胞瘤患者的疗效对比

Comparison of ifosfamide in combination with liposomal doxorubicin and dexamethasone in the treatment of relapsed/refractory multiple myeloma with or without extramedullary plasmacytoma

目的 对比分析复发/难治多发性骨髓瘤（MM）中有无髓外浆细胞瘤（EMP）经异环磷酰胺、多柔比星脂质体、地塞米松（CDD）联合方案治疗的临床疗效.方法 对2011年1月至2016年12月收治的71例复发/难治MM患者的临床资料进行回顾性分析,其中无EMP患者48例（A组）,伴有EMP患者23例（B组）,应用CDD联合方案治疗,1个疗程为21或28 d,治疗2个疗程后进行疗效评估.结果 A组总有效率为43.8%（21/48）,完全缓解及接近完全缓解率为8.3%（4/48）;B组总有效率为65.2%（15/23）,完全缓解及接近完全缓解率为13.0%（3/23）,B组总有效率、完全缓解及接近完全缓解率与A组比较虽有增高趋势,但差异无统计学意义（χ^2=1.203、0.659,P〉0.05）.A组无进展生存时间（8.6 ± 3.3）个月,B组无进展生存时间（7.9 ± 2.5）个月,两组比较差异无统计学意义（t=1.009,P〉0.05）.两组不良反应发生率比较差异无统计学意义（P〉0.05）.结论 复发/难治MM中有无EMP患者经CDD联合方案治疗均可获得较好疗效,无进展生存时间及药物相关不良反应相似,尤其对于有EMP患者疗效略增高.

Objective To compare the clinical effect of ifosfamide in combination with liposomal doxorubicin and dexamethasone （CDD） in the treatment of relapsed/refractory multiple myeloma （MM） with or without extramedullary plasmacytoma （EMP）. Methods The clinical data of 71 relapsed/refractory MM patients treated with CDD regimen from January 2011 to December 2016 were retrospectively analyzed, including 48 patients with EMP（group A）and 23 patients without EMP （group B）.One cycle of the CDD treatment was 21 d or 28 d and efficacy analysis was performed after every two cycles.Results The overall response rate in group A was 43.8%（21/48）and the complete remission and near complete remission rate was 8.3%（4/48）;the overall response rate in group B was 65.2%（15/23）and the complete remission and near complete remission rate was 13.0% （3/23）. There were no statistically significant differences between the two groups（χ^2=1.203,0.659,P〉0.05）.The progression-free survival （PFS）time in group A was（8.6 ± 3.3）months, while the PFS time in group B was（7.9 ± 2.5）months and there was no significant difference between the two groups（t=1.009,P〉0.05）.There was no significant difference about incidence rate of adverse effects between the two groups（P〉0.05）.Conclusions CDD regimen can be used for the treatment of relapsed/refractory MM with or without EMP, the PFS and drug related adverse effects are similar, especially in patients with EMP.