BD方案与VAD方案治疗多发性骨髓瘤的疗效比较

摘要

目的 比较硼替佐米联合地塞米松方案(BD方案)与VAD方案治疗多发性骨髓瘤的临床疗效及安全性.方法 回顾性分析120例多发性骨髓瘤病例,根据其治疗方案分为:(1)BD组(n=37):其中初治16例,复材难治21例;(2)VAD组(n=83):其中初治39例,复发,难治44例.化疗4-7个疗程后全面评价两组疗效及副反应.采用EBMTIABMT标准判定疗效,并按WHO标准判断不良反应.结果 (1)BD组:中位生存期为43.5个月,2年和4年生存率分别为86.4%和47.3%,平均起效疗程数为2.06,总有效率为91.9%,其中CR/nCR 32.4%(12/37),PR 48.6%(18/37),MR 10.8%(4/37).初治患者CR/nCR 37.5%(6/16),PR 50.0%(8/16),MR 6.3%(1/16),NR 6.3%(1/16),有效率为93.8%;复发/难治患者CR/nCR 28.6%(6/21),PR 47.6%(10/21),MR 14.3%(3/21),NR 4.8%(1/21),PD 4.8%(1/21),有效率为90.5%;(2)VAD组:中位生存期为29.1个月,2年和4年生存率分别为64.3%和33.5%,平均起效疗程数为3.09,总有效率为66.3%,其中CR/nCR 12.O%(10/83),PR 38.6%(32,83),MR15.7%(13/83).初治患者CR/nCR 15.4%(6/39),PR 38.5%(15/39),MR 12.8%(5/39),NR 20.5%(8139),PD 12.8%(5/39),有效率66.7%;复发/难治患者CR/nCR 9.1%(4/44),PR 38.6%(17/44),MR 18.2%(8/44),NR 18.2%(8/44),PD 15.7%(7/44),有效率为65.9%.x2检验结果显示,2组方案疗效之间比较差异有统计学意义(P<0.05);经Log-rank检验发现,2组生存率比较差异有统计学意叉(P<0.05);(3)与VAD组相比,BD组不良反应较轻微,患者耐受性较好.结论 与VAD方案相比,BD方案能达到更高的缓解率,显著延长患者的生存期,并提高患者的生活质量,疗效显著,毒副反应小,耐受性好.%Objective To compare the efficacy and safety between bortezomib in combination with dexamethasone regimen (BD regimen) and VAD regimen in treatment of multiple myeloma. Methods Totally 120 patients with multiple myeloma were analysed retrospectively and were divided into two groups according to their treatment protocols:BD group(37 cases),of which 16 were newly diagnosed and 21 were relapsed/refractory;VAD group(83 cases),of which 39 were newly diagnosed and 44 were relapsed/refractory.The effectiveness and toxicity of the two regimens were evaluated comprehensively after 4 to 7 courses of chemotherapy. EBMT and WHO criterias were used to assess the therapeutic and the adverse effects,respectively. Results The median survival time,2- and 4-year overall survival rates and the average response courses of the BD group were 43.5 months,86.4％ and 47.3％,and 2.06,respectively and the overall response rate was 91.9％[CR/ nCR 32.4％(12/37),PR 48.6％(18/37),MR 10.8％(4/37) ]. In BD group,the overall response rate of newly diagnosed patients was 93.8％ [CR/nCR 37.5％(6/16),PR 50.0％(8/16),MR 6.3％ (1/16),NR 6.3％(1/16) ] ;the overall response rate in relapsed/refractory patients was 90.5％ [ CR/nCR 28.6％(6/21 ), PR 47.6％( 10/21 ), MR 14.3％ ( 3/21 ), NR 4.8％( 1/21 ), PD 4.8％ ( 1/21 ) ].The median survival time, 2- and 4-year overall survival rates and the average response courses of VAD group were 29.1 months,64.3％ and 33.5％,and 3.09,respectively and the overall response rate was 66.3％[CR/nCR 12.0％( 10/83 ), PR 38.6％ (32/83), MR 15.7％(13/83) ].In VAD group,the overall response rate of newly diagnosed patients was 66.7％[CR/nCR 15.4％(6/39),PR 38.5％( 15/39),MR 12.8％(5/39),NR 20.5％(8/39), PD 12.8％(5/39)];the overall response rate in relapsed/refractory patients was 65.9％[CR/nCR 9.1％(4/44),PR 38.6％(17/44),MR 18.2％(8/44),NR 18.2％(8/44),PD 15.7％ (7/44) ]. x2 test and the Log-rank test showed that there was significant difference in overall response rate and survival rate respectively between the two groups(P ＜ 0.05 ). Compared with VAD group,the adverse reactions of BD group were milder andthe patients had better tolerance. Conclusion Compared with VAD regimen, BD regimen can achieve a higher response rate and a longer median survival time while improving the life quality of patients, and has more dramtic effects with less adverse effects and better tolerance of patients.