BD 和 VAD －T 方案治疗复发性／难治性多发性骨髓瘤的临床疗效比较

摘要

目的：分析 BD 方案和 VAD －T 方案治疗复发难治性多发性骨髓瘤患者的疗效及毒副反应。方法：将24例和38例患者分别用硼替佐米联合的 BD 方案治疗和沙利度胺联合的 VAD －T 方案治疗。每例患者接受同一方案治疗至少4个疗程。采用国际骨髓瘤工作组（IMWG）国际统一疗效标准评价疗效，并按 WHO肿瘤药物毒副反应分级标准观察毒副反应。结果：BD 方案组中24例患者中完全缓解（CR）6例，非常好地部分缓解（VGPR）11例，部分缓解（PR）5例，疾病稳定（SD）2例，总有效率（CR ＋VGPR ＋PR）91．7％；VAD －T方案组38例患者中 CR 1例，VGPR 3例，PR 18例，SD 11例，病情进展（PD）5例，总有效率57．9％，两组疗效比较差异有统计学意义（P ＜0．01）。两组患者主要毒副反应为周围神经病变、呕吐、便秘、感染、血小板减少、静脉血栓等，经对症处理或停药后缓解、减轻。BD 方案组患者毒副反应较 VAD －T 方案组患者重，但经对症处理后均可耐受。结论：与 VAD －T 方案相比，BD 方案治疗复发难治性 MM更有效，且毒副反应可耐受，BD方案的预后处理很重要。%Objective:To compare the efficacy and adverse effects of BD and VAD -T regimens in relapsed /re-fractory multiple myeloma(MM).Methods:There were 24 and 38 relapsed /refractory MMpatients in BD and VAD -T groups,respectively.Every patient accepted each regimen at least 4 cycles.We use the unified international standard of International Myeloma Working Group(IMWG)to evaluate curative effect,and observe the adverse reactions by WHO antitumor drugs adverse reactions grading standard.Results:There were 6,11,5,2 and 0 patients achieved complete remission(CR),very good partial remission(VGPR),partial remission(PR),stable disease(SD)and pro-gressive disease(PD),in BD group respectively.In VAD -T group,the number were 1,3,18,11 and 5.The rate of patients who achieved good efficacy(CR +VGPR +PR)in BDT group was 91.6%,which was higher than that in VAD -T group(57.9%),(P <0.01).The main adverse reactions of two groups were peripheral neuropathy,emesis, constipation,infection,thrombocytopenia,venous thrombosis,and so on.The adverse reactions released and relieved after symptomatic treatment or discontinuation.However,the adverse reaction in BD group were worse than VAD -T group.Conclusion:Compared with the VAD -T chemotherapy,BD was more effective in relapsed /refractory MM, while the adverse effects were well tolerated.Preventive medical care is necessary in BDT protocol.