含硼替佐米PAD、PCD、VRD方案治疗初治多发性骨髓瘤的效果及对细胞免疫指标、安全性的影响

Efficacy of Bortezomib-containing PAD,PCD and VRD Regimens in the Treatment of Newly-treated Multiple Myeloma and Its Impact on Cellular Immune Indexes and Safety

目的分析含硼替佐米PAD、PCD、VRD方案治疗初治多发性骨髓瘤的效果及对细胞免疫指标、安全性的影响。方法收集2017年10月—2019年12月收治的78例多发性骨髓瘤,按不同化疗方案分为VRD(硼替佐米+来那度胺+地塞米松)组26例、PCD(硼替佐米+环磷酰胺+地塞米松)组18例、PAD(硼替佐米+阿霉素+地塞米松)组34例。比较3组临床疗效、细胞免疫指标及不良反应发生情况。随访记录患者总生存率与无进展生存率。结果VRD组总有效率高于PCD组和PAD组(P<0.05)。治疗后,3组CD3+、CD4+、CD4+/CD8+及调节性T淋巴细胞水平均较治疗前增高(P<0.05),但治疗后3组间比较差异无统计学意义(P>0.05)。VRD组周围神经病变发生率高于PCD组和PAD组(P<0.05)。3组肺部感染、血小板减少、白细胞减低、消化道反应及疱疹发生率比较差异无统计学意义(P>0.05)。3组总生存率、无进展生存率比较差异无统计学意义(P>0.05)。结论含硼替佐米PAD、PCD、VRD方案治疗初治多发性骨髓瘤均具有一定疗效,以VRD方案更为突出,但需注意周围神经病变等不良反应。

Objective To analyze the effect of bortezomib-containing PAD,PCD and VRD regimens in the treatment of newly-treated patients with multiple myeloma and their effects on cellular immune indexes and safety.Methods A total of 78 cases of multiple myeloma treated from October 2017 to December 2019 were collected and divided into VRD(Bortezomib+Lenalidomide+Dexamethasone)group(n=26),PCD(Bortezomib+Cyclophosphamide+Dexamethasone)group(n=18),and PAD(Bortezomib+Doxorubicin+Dexamethasone)group(n=34)according to different chemotherapy regimens.The clinical efficacy,cellular immune indexes and adverse reactions were compared among the three groups.The patients'overall survival(OS)and progression-free survival(PFS)were recorded during follow-up.Results The total effective rate in VRD group was higher than that in PCD group and PAD group(P<0.05).After treatment,the levels of CD3+,CD4+,CD4+/CD8+and regulatory T lymphocytes in the three groups were all higher than those before treatment(P<0.05),but there was no significant difference among the three groups after treatment(P>0.05).The incidence of peripheral neuropathy in VRD group was higher than that in PCD group and PAD group(P<0.05).There was no significant difference in the incidence of pulmonary infection,thrombocytopenia,leukopenia,digestive tract reaction and herpes between the three groups(P>0.05).There was no significant difference in OS rate and PFS rate among the three groups(P>0.05).Conclusion Bortezomib-containing PAD,PCD,and VRD regimens have certain curative effects in the treatment of newly-treated multiple myeloma,among which the VRD regimen is more prominent,but attention should be paid to adverse reactions such as peripheral neuropathy.