ABCD方案治疗复发/难治性多发性骨髓瘤的效果

Clinical efficacy of ABCD regimen for relapsed/refractory multiple myeloma

目的观察ABCD方案治疗复发/难治性多发性骨髓瘤(MM)的效果和不良反应。方法回顾性分析2013年11月~2015年5月解放军总医院第一附属医院老年肿瘤科收治的5例复发/难治性MM患者的临床特征,包括年龄、性别、血生化及骨髓特点等。应用ABCD方案化疗(表柔比星40 mg/m^2d1,卡莫司汀62.5 mg d1,环磷酰胺600 mg/m^2d1,地塞米松20 mg d1~d4),观察其治疗效果及不良反应。结果 5例患者中,男1例,女4例,年龄48~74岁,治疗前骨髓瘤细胞百分比中位数为7.75%,中位血β_2微球蛋白和白蛋白浓度分别为3.3μg/L和37.9 g/L。接受了ABCD方案化疗,中位疗程数为5个,部分缓解3例,微小缓解1例,稳定1例,中位无进展生存期为4个月。主要的不良反应是消化道症状(Ⅱ度3例)和乏力(Ⅱ度3例),1例发生Ⅲ度骨髓抑制并合并肺部感染。结论 ABCD方案治疗复发/难治性MM,有效率较高,耐受性良好,值得进一步临床观察和推广。

Objective To investigate the therapeutic effectiveness and side effects of ABCD regimen for relapsed/refractory multiple myeloma（MM）. Methods Clinical data of 5 patients suffered from relapsed/refractory MM from November 2013 to May 2015 were analyzed retrospectively, including age, sex, peripheral blood and bone marrow characteristics and so on. These patients were treated by ABCD regimen（Epirubicin 40 mg/m^2 d1, Carmustine 62.5 mg d1,Cyclophosphamide 600 mg/m^2 d1, Dexamethasone 20 mg d1-4） for 3 to 6 course. The therapeutic effectiveness and side effects were evaluated. Results Among 5 patients, 1 patient was male and 4 patients were females with the age ranged from 48 years to 74 years. Their median myeloma cell ratio was 7.75%, median blood serum β_2 microglobulin and albumin was 3.3 μg/L and 37.9 g/L before salvage therapy, respectively. The median course of treatment received by the series was 5. After treatment by ABCD regimen, 3 patients achieved partial remission, 1 patient achieved minimal response, 1 patient achieved stable disease. The median progression survival time was 4 months. The main side effects of treatment were grade 2 of gastrointestinal symptom（3 cases） and fatigue（3 cases）, 1 case of grade 3 bone marrow and lung infection. Conclusion ABCD regimen is promising for the treatment of relapsed/refractory MM patients in terms of overall response rate and manageable adverse effects.