以硼替佐米为主的化疗方案治疗复发难治性多发性骨髓瘤临床效果观察

摘要

Objective To examine the recent clinical efficacy and safety of bortezomib-based chemotherapy treating replapsed or refractory multiple myeloma(RRMM).Methods Forty-five patients with RRMM receiving Bortezomib-based regimen treatment from January 2009 to December 2012 were analyzed retrospectively.25 cases were male; 20 were female; age ranged between 37 and 78 years with a mean of(57 ± 2).Fifteen patients were treated with PAD regimen (Bortezomib,adriamycin,dexamethasone).Fifteen patients were treated with PCD (Bortezomib,CTX,dexamethasone).Eight patients received PD regimen (Bortezomib,dexamethasone).Seven patients received PDT (Bortezomib,thalidomide,dexamethasone) ; every patient received 6-8 cycles of chemotherapy.The efficacy was evaluated according to the criteria of European Group for Blood and Marrow Transplanatation.Adverse events were graded according to the criteria of WHO.Results The median follow-up time was 25 months (5-35).15 patients were treated with PAD chemotherapy regimens; the effective rate was 93.3％ (14/15).The complete response (CR) /the near complete response (nCR) was 46.7％ (7/15) ; the very good complete response (VGPR) was 20％ (3/15) ; the partial response (PR) was 13.3％ (2/15) ; the minor response (MR) was 13.3％ (2/15) ; SD was 6.7％ (1/15).15 patients were treated by PCD chemnotherapy regimens; the effective rate was 93.3％ (14/15).The complete response(CR) /the near complete response(nCR) was 46.7％ (7/15) ;the very good complete response (VGPR) was 20％ (3/15) ; the partial response (PR) was 20％ (3/15) ; the minor response (MR) was 6.7％ (1/15) ; SD was 6.7％ (1/15).There was no statistical significance in two difference groups regarding PAD and PCD(P ＞ 0.05).8 patients were treated by PD and the effective rate was 75％ (6/8).The complete response(CR) /the near complete response(nCR) was 37.5％ (3/8) ; the very good complete response (VGPR) was 12.5％ (1/8) ; the partial response (PR) was12.5％ (1/8) ; the minor response (MR) was 12.5％ (1/8) ; SD was 1 2.5％ (1/8).7 patients were treated by PTD chemotherapy regimens; the effective rate was 85.7％ (7/8).The complete response (CR) /the near complete response (nCR) was 28.6％ (2/7) ; the very good complete response (VGPR) was 14.3％ (1/7) ; the partial response (PR) was 14.3％ (1/7) ; the minor response (MR) was 14.3％ (1/7) ; SD was 14.3％ (1/7).There was no statistical significance in two difference groups by PD and PTD (P ＞ 0.05).6 cases had limbs numbness because of Bortezomib.The major adverse events during treatment were peripheral neuropathy,gastrointestinal disorder,herpes zoster and infection,hematology toxicity,fatigue and baldness.These side effects could be controlled by adjusting drug doses,drug withdrawal or symptomatic treatment.Conclusions Bortezomib based chemotherapy is well tolerated and is an effective regimen in treatment of RRMM.The adverse effects are predictable and manageable.%目的 观察硼替佐米为主的化疗方案治疗复发难治性多发性骨髓瘤的近期疗效与安全性.方法 对2009年1月至2012年12月采用硼替佐米联合化疗方案治疗45例复发难治性多发性骨髓瘤患者的临床资料进行回顾性分析.患者中男25例,女20例,年龄37～ 78岁,平均(57±2)岁.其中15例接受PAD(硼替佐米、阿霉素、地塞米松)方案,15例接受PCD(硼替佐米、环磷酰胺、地塞米松)方案,8例接受PD(硼替佐米、地塞米松)方案,7例接受PDT(硼替佐米、地塞米松、沙利度胺)方案.按照欧洲骨髓移植协作组标准评价疗效(EBMT),世界卫生组织(WHO)标准判断不良反应.结果 随访25(5 ～35)个月,采用PAD方案治疗的15例患者有效率93.3％,其中完全缓解+接近完全缓解7例、非常好的部分缓解3例、部分缓解2例、轻微反应2例、疾病稳定1例.采用PCD方案治疗15例患者有效率93.3％(14/15),其中完全缓解+接近完全缓解7例、非常好的部分缓解3例、部分缓解3例、轻微反应1例、疾病稳定1例.采用PAD与PCD方案有效率差异无统计学意义(P＞0.05).采用PD方案治疗8例患者有效率75.0％(6/8),其中完全缓解+接近完全缓解3例、非常好的部分缓解1例、部分缓解1例、轻微反应1例、疾病稳定1例、疾病进展1例.采用PDT方案治疗7例患者有效率85.7％ (6/7),其中完全缓解+接近完全缓解2例、非常好的部分缓解1例、部分缓解1例、轻微反应1例、疾病稳定1例、疾病进展1例.采用PD与PTD方案2组临床疗效差异无统计学意义(P＞0.05).22例患者出现外周神经病变,主要表现为肢端麻木、感觉减退,其中15例为Ⅰ～Ⅱ级.6例因同时使用硼替佐米、沙利度胺出现肢端麻木,停用沙利度胺后临床症状逐渐缓解,1例为Ⅲ级.主要不良反应为周围神经病变、胃肠道症状、带状疱疹及感染、血液系统不良反应、乏力、脱发.但通过对症治疗及调整药物剂量或停药后均能改善.结论 硼替佐米为主的方案治疗复发难治性多发性骨髓瘤,有较高的治疗反应率,不良反应可有效得到控制,大多数患者总体耐受性好,但远期疗效有待进一步临床观察.