中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2009年
4期
260-263
,共4页
张永清%梁蓉%白庆咸%张涛%杨岚%王一苇%王文清%顾宏涛%舒汩汩%朱华锋%白燕妮%陈协群
張永清%樑蓉%白慶鹹%張濤%楊嵐%王一葦%王文清%顧宏濤%舒汩汩%硃華鋒%白燕妮%陳協群
장영청%량용%백경함%장도%양람%왕일위%왕문청%고굉도%서율율%주화봉%백연니%진협군
硼替佐米%阿霉素%地塞米松%难治性%多发性骨髓瘤
硼替佐米%阿黴素%地塞米鬆%難治性%多髮性骨髓瘤
붕체좌미%아매소%지새미송%난치성%다발성골수류
Bortezomib%Doxorubicin%Dexamethasone%Refractoriness%Multiple myeloma
目的 探讨PAD(硼替佐米+阿霉素+地塞米松)方案治疗复发或难治性多发性骨髓瘤(MM)的疗效及安全性.方法 17例复发或难治性MM患者给予硼替佐米(1.3 mg/m2,第1、4、8、11天快速静脉注射)、阿霉素(10 mg/d,第1～4天静脉滴注)和地塞米松(40 mg/d,第1～4天静脉滴注)治疗2～8个疗程,疗效评估依据国际2006疗效反应标准,毒性分级按美国国立癌症研究院不良事件通用名(NCI CTCAE)v 3.0判断.结果 2～4个疗程PAD治疗后,14例(82.4%)患者获部分缓解(PR)以上疗效反应,其中完全缓解(CR)4例(23.5%),很好的部分缓解(VGPR)4例(23.5%),PR 6例(35.3%),疾病稳定(SD)3例(17.6%),中位疾病进展时间为9.5个月,获疗效中位疗程数为1.6(1～3)个.其中5例合并髓外浆细胞瘤患者首次给予PAD方案即达PR以上疗效,1～2个疗程后髓外病灶消失.治疗过程中发现血小板减少9例(52.9%),白细胞减少4例(23.5%),周围神经炎4例(23.5%),带状疱疹3例(17.6%),乏力6例(35.3%),腹泻2例(11.7%).以上不良反应经对症治疗后缓解或消失,1例患者于PAD治疗第5个疗程时发生进行性呼吸功能衰竭死亡.结论 PAD方案可有效治疗复发或难治性MM,特别对伴有髓外浆细胞浸润的MM患者效果更为显著,疗效与传统化疗预后因素无关,常见不良反应经对症治疗可缓解,少数患者发生呼吸功能衰竭可能与硼替佐米潜在的肺毒性有关.
目的 探討PAD(硼替佐米+阿黴素+地塞米鬆)方案治療複髮或難治性多髮性骨髓瘤(MM)的療效及安全性.方法 17例複髮或難治性MM患者給予硼替佐米(1.3 mg/m2,第1、4、8、11天快速靜脈註射)、阿黴素(10 mg/d,第1～4天靜脈滴註)和地塞米鬆(40 mg/d,第1～4天靜脈滴註)治療2～8箇療程,療效評估依據國際2006療效反應標準,毒性分級按美國國立癌癥研究院不良事件通用名(NCI CTCAE)v 3.0判斷.結果 2～4箇療程PAD治療後,14例(82.4%)患者穫部分緩解(PR)以上療效反應,其中完全緩解(CR)4例(23.5%),很好的部分緩解(VGPR)4例(23.5%),PR 6例(35.3%),疾病穩定(SD)3例(17.6%),中位疾病進展時間為9.5箇月,穫療效中位療程數為1.6(1～3)箇.其中5例閤併髓外漿細胞瘤患者首次給予PAD方案即達PR以上療效,1～2箇療程後髓外病竈消失.治療過程中髮現血小闆減少9例(52.9%),白細胞減少4例(23.5%),週圍神經炎4例(23.5%),帶狀皰疹3例(17.6%),乏力6例(35.3%),腹瀉2例(11.7%).以上不良反應經對癥治療後緩解或消失,1例患者于PAD治療第5箇療程時髮生進行性呼吸功能衰竭死亡.結論 PAD方案可有效治療複髮或難治性MM,特彆對伴有髓外漿細胞浸潤的MM患者效果更為顯著,療效與傳統化療預後因素無關,常見不良反應經對癥治療可緩解,少數患者髮生呼吸功能衰竭可能與硼替佐米潛在的肺毒性有關.
목적 탐토PAD(붕체좌미+아매소+지새미송)방안치료복발혹난치성다발성골수류(MM)적료효급안전성.방법 17례복발혹난치성MM환자급여붕체좌미(1.3 mg/m2,제1、4、8、11천쾌속정맥주사)、아매소(10 mg/d,제1～4천정맥적주)화지새미송(40 mg/d,제1～4천정맥적주)치료2～8개료정,료효평고의거국제2006료효반응표준,독성분급안미국국립암증연구원불량사건통용명(NCI CTCAE)v 3.0판단.결과 2～4개료정PAD치료후,14례(82.4%)환자획부분완해(PR)이상료효반응,기중완전완해(CR)4례(23.5%),흔호적부분완해(VGPR)4례(23.5%),PR 6례(35.3%),질병은정(SD)3례(17.6%),중위질병진전시간위9.5개월,획료효중위료정수위1.6(1～3)개.기중5례합병수외장세포류환자수차급여PAD방안즉체PR이상료효,1～2개료정후수외병조소실.치료과정중발현혈소판감소9례(52.9%),백세포감소4례(23.5%),주위신경염4례(23.5%),대상포진3례(17.6%),핍력6례(35.3%),복사2례(11.7%).이상불량반응경대증치료후완해혹소실,1례환자우PAD치료제5개료정시발생진행성호흡공능쇠갈사망.결론 PAD방안가유효치료복발혹난치성MM,특별대반유수외장세포침윤적MM환자효과경위현저,료효여전통화료예후인소무관,상견불량반응경대증치료가완해,소수환자발생호흡공능쇠갈가능여붕체좌미잠재적폐독성유관.
Objective To investigate the efficacy and safety of PAD[bortezomib(PS-341),doxorubicin and dexamethasone]regimen for relapsed or refractory multiple myeloma(MM).Methods Seventeen patients with relapsed or refractory MM received two to four 21-day cycles of PAD:an intravenous bolus of bortezomib(1.3 mg/m2)on days 1,4,8,and 11;doxorubicin 10mg per day on days 1 to 4,and dexamethasone 40mg on days 1-4.Response was evaluated according to International Myeloma Working Group Criteria(IMWG 2006),toxicity was graded according to NCI CTCAE(common terminology criteria for adverse events)v 3.0.Results After 2-4 courses of PAD,14 patients(82.4%)responsed.including complete response(CR)in 4(23.5%),very good partial response(VGPR)in4(23.5%),partial response(PR)in 6(35.3%)and stable disease(SD)in 3(17.6%).Median time to progression was 9.5 monks.The median course to response was 1.6(1-3).All of 5 patients with extrameduUary plasmacytoma achieved at least PR after the first cycle therapy;the plasmacytoma disappeared after 1-2 cycles of PAD.The efficacy was independent of other prognostic factors such as β2-MG.Adverse events included thrombocytopenia in 9 patients(52.9%),leukopenia in 4(23.5%),peripheral neuropathy in 4(23.5%),varicella herpes zoster in 3(17.6%),fatigue in 6(35.3%)and diarrhea in 2(11.7%).All of these adverse reactions could be controlled with routine supportive treatmemt,only one patient died from respiratory failure during his fifth PAD cycle.Conclusions PAD regimen should be considered as an appropriate treatment for relapsed or refractory MM,especially for MM with extramedullary plasmacytoma.Its efficacy is independent of traditional prognostic factors.The side effects are usually manageable.
