论文部分内容阅读
目的观察硼替佐米联合地塞米松(PD)在多发性骨髓瘤(MM)中的应用。方法 2008年2月至2010年4月北京积水潭医院36例MM患者接受PD治疗。以同期46例VADT化疗的MM患者做为对照。分析病情转归及不良反应。结果 (1)PD用于初治和复发和(或)难治MM患者疗效均显著。初治组治疗有效率85.7%(18/21);复发和(或)难治组的有效率为80.0%(12/15);总有效率为83.3%(30/36)。PD与VADT治疗初治MM的有效率差异无统计学意义(85.7%对78.1%,P=0.740),PD治疗复发和(或)难治MM的有效率明显高于VADT组(80.0%对42.9%,P=0.039)。PD起效快,治疗有效的患者均在1个疗程后达PR;63.9%患者在3个疗程内达到VGPR以上缓解,优于VADT组的30.4%。(2)PD不良反应主要有乏力、周围神经病变及血小板减少等。PD治疗初治MM较复发和(或)难治MM不良反应小,耐受性好,更能坚持长期化疗以获得最大缓解。(3)PD治疗的MM患者骨痛缓解快,全身骨密度增高较VADT组更显著[(1.138±0.102)g/cm2对(1.053±0.137)g/cm2,P=0.039)]。结论硼替佐米联合地塞米松治疗MM缓解率高,可首选用于治疗初治及复发和(或)难治MM。
Objective To observe the application of bortezomib combined with dexamethasone (PD) in multiple myeloma (MM). Methods From February 2008 to April 2010, 36 patients with MM in Beijing Jishuitan Hospital received PD. In the same period 46 cases of MM patients with VADT chemotherapy as a control. Analysis of the outcome and adverse reactions. Results (1) The efficacy of PD for both naive and recurrent and / or refractory MM patients was significant. The effective rate was 85.7% (18/21) in the initial treatment group and 80.0% (12/15) in the recurrent and / or refractory group. The total effective rate was 83.3% (30/36). The effective rates of PD and VADT in treating untreated MM were not statistically different (85.7% versus 78.1%, P = 0.740). The effective rate of PD in relapsed and / or refractory MM was significantly higher than that in VADT (80.0% vs. 42.9 %, P = 0.039). The onset of PD was rapid and the effective treatment reached PR after 1 course of treatment. 63.9% of the patients achieved VGPR above 3 courses of treatment, which was better than 30.4% of VADT group. (2) PD adverse reactions are mainly fatigue, peripheral neuropathy and thrombocytopenia. PD treatment of primary treatment of MM recurrence and (or) refractory MM adverse reactions, tolerability, and more able to adhere to long-term chemotherapy to obtain maximum remission. (3) The bone mineral density in PD patients treated with PD was relieved quickly and the whole body BMD increased more significantly than that in VADT group (1.053 ± 0.137 g / cm2 vs. (1.138 ± 0.102) g / cm2, P = 0.039). Conclusion Bortezomib and dexamethasone treatment of high MM remission rate, may be the first choice for the treatment of initial and recurrence and (or) refractory MM.