VD方案联合环磷酰胺或沙利度胺治疗初治多发性骨髓瘤疗效分析

The effect of VCD and VTD on the treatment of multiple myeloma

目的探讨VCD方案(硼替佐米、环磷酰胺、地塞米松)和VTD方案(硼替佐米、沙利度胺、地塞米松)治疗初治多发性骨髓瘤(MM)的疗效和不良反应,为多发性骨髓瘤临床治疗方案的选择提供依据。方法回顾性分析120例老年初治多发性骨髓瘤患者的治疗情况,其中VCD治疗组56例,VTD治疗组64例。至少完成2个疗程后判断疗效,并比较不良反应发生情况。结果VCD治疗组总反应率(ORR)66.4%(37/56),其中完全缓解(CR)32.4%(18/56),非常好的部分缓解(VGCR)18.8%(11/56),部分缓解(PR)15.2%(8/56);VTD治疗组总反应率(ORR)79.7%(51/64),其中完全缓解(CR)46.1%(29/64),非常好的部分缓解(VGCR)20.3%(13/64),部分缓解(PR)13.3%(9/64)。两治疗组ORR(P=0.040)、CR(P=0.042)差异有统计学意义(P<0.05),而VGCR、PR差异无统计学意义(P>0.05)。不良反应中,周围神经病变发生率VTD治疗组高于VCD治疗组,差异无统计学意义(P=0.098)。结论对于多发性骨髓瘤的治疗VTD方案总反应率优于VCD方案,不良反应中周围神经病变发生率VTD方案高于VCD方案,差异虽无统计学意义,但有临界统计学意义的趋势。

Objective To investigate the efficacy and adverse reactions of VCD regimens（bortezomib,cyclophosphamide,dexamethasone） and VTD regimens（bortezomib,thalidomide,dexamethasone） in the treatment of newly diagnosed multiple myeloma. And to provide the basis for the selection of clinical treatment options for multiple myeloma. Methods A retrospective analysis was performed on the treatment of 120 cases of multiple myeloma,including 56 cases treated with VCD and 64 cases treated with VTD. The curative effect was judged and the occurrence of adverse reactions after completing at least 2 courses of treatment was compared. Results The overall response rate of VCD treatment group was 66. 4%,of which complete remission was 32. 4%,very good partial remission was 18. 8%,partial remission was 15. 2%; Overall response rate in VTD treatment group was 79. 7%,with complete remission 46. 1%,very good partial remission was 20.3%,partial remission was 13. 3%. The difference between ORR（P = 0. 040） and CR（P = 0. 042） was statistically significant between the two treatment groups,but there was no significant difference between VGCR and PR（P 〉0.05）. In adverse reactions,the incidence of peripheral neuropathy was higher in the VTD treatment group than in the VCD treatment group（P 〉0.05）. Conclusion The total response rate of VTD regimen for multiple myeloma is better than that of VCD regimen. The incidence of peripheral neuropathy in adverse reactions is higher than VCD regimen in VTD regimen. Although the difference is not statistically significant,there is a trend of borderline statistical significance.