沙利度胺联合VAD治疗难治或复发性多发性骨髓瘤的临床观察

摘要

目的 观察沙利度胺联合VAD治疗难治性或复发性多发性骨髓瘤(MM)的临床疗效及不良反应.方法 49例患者难治性或复发性MM患者随机分为沙利度胺联合VAD组(n=25)和VAD组(n=24).A组:25例患者接受沙利度胺联合VAD化疗方案(VAD:(长春新碱0.4 mg/d静脉注射,第1～4 d;多柔比星10 mg/d静脉注射,第1～4 d;地塞米松40 mg/d口服,第1～4 d,9-12 d和第17～20 d);沙利度胺200 mg/d口服).B组:24例患者接受VAD方案(同上).每治疗周期为28 d,持续4个周期后评价治疗效果.结果 A组和B组最终病例数分别为25例和23例(B组1例男性患者死亡).2组的治疗有效率分别为80%和47.8%,A组的疗效明显优于B组(P<0.05).A组较B组更容易产生便秘、嗜睡(P<0.05),2组患者的副反应程度均可耐受.结论 沙利度胺联合VAD较单纯VAD方案治疗难治性或复发性MM具有更好的治疗效果,患者能够很好的耐受.%Objective To investigate the clinical responses and the side - effects of thalidomide combined with VAD in treating patients with relapsed or refractory multiple myeloma ( MM ). Methods Forty - nine patients with relapsed or refractory MM were randomly divided into two groups. Group A ( n = 25 ) received treatment of thalidomide ( given daily at a dose of 200 mg ) combined withVAD ( vin-desine 1 ～2 mg intravenously on days 1 ～4; liposomal doxorubicin 20 mg/d i. v. administered on days 1 ～4; dexamethasone 40 mg per os daily on days 1 ～4 and 15 ～ 18 ), and 24 patients ( group B ) were given chemotherapeutic regimen VAD, which is the same regimen as regimen A without thalidomide. Response to treatment was evaluated after four cycles of treatment ( one cycle persisted 28 days ). Results The final number of patients in group A was 25 and B was 23 ( one male patient died ). The overall response rate of the group A and group B was 80% and 47. 8% ( P < 0.05 ), respectively. In terms of constipation and somnolence, group A showed a higher incidence compared to group B ( each,P<0.05 ). These two regimens were easy to tolerate. Conclusion Regimen A in patients with relapsed or refractory MM is more effective compared to regimen B in terms of its comparable response rate. This therapy has mild adverse reactions and is easy to tolerate.