环磷酰胺治疗多发性骨髓瘤的临床疗效及安全性

Clinical efficacy and safety of cyclophosphamide in the treatment of multiple myeloma

目的探讨环磷酰胺治疗多发性骨髓瘤的临床疗效及安全性。方法依据治疗方案的不同将88例多发性骨髓瘤患者分为沙利度胺组和环磷酰胺组,每组44例,沙利度胺组患者给予沙利度胺+硼替佐米+地塞米松治疗,环磷酰胺组患者给予环磷酰胺+硼替佐米+地塞米松治疗。治疗10个疗程后,比较两组患者的临床疗效、细胞因子及蛋白[M蛋白、血红蛋白(Hb)、骨髓浆细胞计数、血小板因子4(PF4)、β2微球蛋白(β2-MG)]水平、肾功能指标[血尿素氮(BUN)、肌酐、尿酸]、免疫因子指标[转化生长因子-β(TGF-β)、白细胞介素(IL)-6、IL-17]和不良反应发生情况。结果环磷酰胺组患者的临床疗效优于沙利度胺组(P﹤0.01)。治疗后,环磷酰胺组患者M蛋白、骨髓浆细胞计数、β2-MG水平均低于沙利度胺组(P﹤0.05),Hb、PF4水平均高于沙利度胺组(P﹤0.05)。治疗后,沙利度胺组患者肌酐水平低于本组治疗前(P﹤0.05),环磷酰胺组患者BUN、肌酐、尿酸水平均低于本组治疗前(P﹤0.05),且环磷酰胺组患者BUN、肌酐、尿酸水平均低于沙利度胺组(P﹤0.05)。治疗后,两组患者TGF-β、IL-6、IL-17水平均低于本组治疗前(P﹤0.05),且环磷酰胺组患者TGF-β、IL-6、IL-17水平均低于沙利度胺组(P﹤0.05)。两组患者各不良反应发生率均无明显差异(P﹥0.05)。结论环磷酰胺治疗多发性骨髓瘤的疗效较好,可明显改善患者的细胞因子及蛋白水平、肾功能指标和免疫因子指标,且不增加不良反应。

Objective To investigate the clinical efficacy and safety of cyclophosphamide in the treatment of multiple myeloma.Method A total of 88 patients with multiple myeloma were divided into thalidomide group and cyclophosphamide group according to different treatment regimens,with 44 cases in each group.The thalidomide group received thalidomide+bortezomib+dexamethasone,while the patients in the cyclophosphamide group were treated with cyclophosphamide+bortezomib+dexamethasone.After 10 cycles of treatment,the clinical efficacy,cytokines and proteins[M protein,hemoglobin(Hb),bone marrow plasma cell count,platelet factor 4(PF4),β2-microglobulin(β2-MG)],renal function indicators[blood urea nitrogen(BUN),creatinine,uric acid],immune factor indicators[transforming growth factor-β(TGF-β),interleukin(IL)-6,IL-17],and the occurrence of adverse events were compared between the two groups.Result The clinical efficacy of the cyclophosphamide group was better than that of the thalidomide group(P<0.01).After the treatment,the M protein,bone marrow plasma cell count,andβ2-MG levels in the cyclophosphamide group were lower than those in the thalidomide group(P<0.05),and the levels of Hb and PF4 were higher than those in the thalidomide group(P<0.05).After treatment,the levels of creatinine in thalidomide group was lower than that before treatment(P<0.05),BUN,creatinine and uric acid in cyclophosphamide group were lower than those before treatment(P<0.05),and the levels of BUN,creatinine and uric acid in cyclophosphamide group were lower than those in thalidomide group(P<0.05).After the treatment,the levels of TGF-β,IL-6,and IL-17 in the two groups were lower than those before the treatment(P<0.05),and the levels of TGF-β,IL-6 and IL-17 in the cyclophosphamide group were lower than those in the thalidomide group(P<0.05).There were no significant differences in the incidence of adverse events between the two groups(P>0.05).Conclusion Cyclophosphamide has good efficacy in the treatment of multiple myeloma,and can significantly improve the cytokines and proteins,renal function indexes and immune factor indexes of patients without increasing adverse reactions.