114例多发性骨髓瘤诊治的临床现状分析

Diagnosis and treatment of multiple myeloma: clinical analysis of 114 cases

目的分析诸暨市人民医院近9年来多发性骨髓瘤诊治的现状。方法回顾2010年1月至2018年10月诸暨市人民医院收治的多发性骨髓瘤患者114例,分析患者的临床资料,观察多发性骨髓瘤患者的疾病类型、疾病分期与肾功能情况、治疗方案与治疗效果。结果 114例多发性骨髓瘤患者中IgG型72例(63.1%),IgA型36例(31.6%),IgD型2例(1.8%),轻链型4例(3.5%);ISS分期以Ⅲ期占绝大多数(83.3%),肾功能损害患者占45.6%。2010至2012年采用传统化疗的患者占64.1%,随着药物慈善政策的开展和药品价格的下调,采用新药联合化疗的患者不断增多,至2017年,绝大多数患者均使用新药联合化疗。除9例患者因各种原因放弃治疗外,48例(45.7%)患者采用传统化疗方案,总有效率为56.3%;57例(54.3%)患者采用新药联合化疗,总有效率为78.9%。新药联合化疗患者总有效率高于传统化疗患者(P<0.05)。采用新药联合化疗患者中位疾病无进展生存期(PFS)、3年总生存率均较传统化疗患者明显提高(中位PFS:21个月vs 6个月;3年总生存率:35.8%vs 4.3%,P<0.05)。结论对于多发性骨髓瘤患者,新药联合化疗较传统化疗更有效。基层医院应尽量为多发性骨髓瘤患者争取最佳治疗时间与机会,在目前尚不能治愈的情况下,使多发性骨髓瘤成为一种慢性疾病,患者可以长期生存。

Objective To analyze the clinical status of diagnosis and treatment of multiple myeloma. Methods Clinical data of114 patients with multiple myeloma admitted in Zhuji People’s Hospital from January 2010 to October 2018 were retrospectively reviewed. The types, stages, renal function, treatment and therapeutic efficacy were analyzed. Results Among 114 patients, 72(63.1%) were IgG type, 36(31.6%) were IgA type, 2(1.8%) were IgD type and 4(3.5%) were light chain type. The majority of ISS stages were stage Ⅲ(83.3%) and renal impairment was abserved in 52 cases(45.6%). From 2010 to 2012, 64.1% of patients received traditional chemotherapy. With the implement of charitable drug policy and the decrease of drug prices, the number of patients using new drugs combined with chemotherapy increased, by 2017 the vast majority of patients used new drugs combined with chemotherapy. Among 114 patients, 9 patients gave up treatment for various reasons;48 patients(45.7%) used traditional chemotherapy with a overall effective rate of 56.3%;57 patients(54.3%) used new drugs combined with chemotherapy with a overall effective rate of 78.9%. The overall effective rate of new drugs combined with chemotherapy was higher than that of traditional chemotherapy(P<0.05). The median disease progression-free survival(PFS) and 3-year overall survival(OS) rates of patients treated with new drugs combined with chemotherapy were significantly higher than those of patients treated with traditional chemotherapy(21 vs 6 months;35.8% vs 4.3%, respectively;both P<0.05). Conclusion New drugs combined with chemotherapy is more effective than traditional chemotherapy for patients with multiple myeloma. Although it can not be completely cured currently, with the development of new drugs multiple myeloma becomes a chronic disease, and patients can survive for a long time.