CAJ | 학술논문

目的：观察硼替佐米为主的化疗方案治疗多发性骨髓瘤( MM)的效果和安全性。方法选择解放军白求恩国际和平医院血液科2010年3月-2013年6月收治的42例MM,其中初发24例,复发难治18例。采用硼替佐米为主的化疗方案(硼替佐米+沙利度胺+地塞米松+表柔比星)治疗,总结疗效,比较治疗前后骨髓内MM细胞百分比及血清M蛋白、β2-微球蛋白变化,观察毒性反应的发生情况。结果本组24例初治MM完全缓解( CR)率为25%,总有效率为87.5%；18例复发难治MM CR率为16.7%,总有效率为49.8%。治疗后患者骨髓内MM细胞百分比及血清M蛋白、β2-微球蛋白水平较治疗前均有明显下降( P<0.01)。27例出现四肢麻木、疼痛,3例出现胸部胀痛,18例出现不同程度的恶心、腹胀、便秘、呕吐、头晕,15例出现血小板下降1~2级,3例出现全血细胞减少,6例出现红色斑丘疹,3例出现带状疱疹,上述患者经对症治疗或延长用药间隔均好转；1例发生肺栓塞,经抢救无效死亡；2例发生脑梗死,经专科治疗后逐渐恢复。结论硼替佐米为主的联合化疗方案对MM尤其是初发患者效果较好,患者总体耐受性可,毒性反应以周围神经病变为主,治疗中要高度重视并积极预防栓塞。
목적：관찰붕체좌미위주적화료방안치료다발성골수류( MM)적효과화안전성。방법선택해방군백구은국제화평의원혈액과2010년3월-2013년6월수치적42례MM,기중초발24례,복발난치18례。채용붕체좌미위주적화료방안(붕체좌미+사리도알+지새미송+표유비성)치료,총결료효,비교치료전후골수내MM세포백분비급혈청M단백、β2-미구단백변화,관찰독성반응적발생정황。결과본조24례초치MM완전완해( CR)솔위25%,총유효솔위87.5%；18례복발난치MM CR솔위16.7%,총유효솔위49.8%。치료후환자골수내MM세포백분비급혈청M단백、β2-미구단백수평교치료전균유명현하강( P<0.01)。27례출현사지마목、동통,3례출현흉부창통,18례출현불동정도적악심、복창、편비、구토、두훈,15례출현혈소판하강1~2급,3례출현전혈세포감소,6례출현홍색반구진,3례출현대상포진,상술환자경대증치료혹연장용약간격균호전；1례발생폐전새,경창구무효사망；2례발생뇌경사,경전과치료후축점회복。결론붕체좌미위주적연합화료방안대MM우기시초발환자효과교호,환자총체내수성가,독성반응이주위신경병변위주,치료중요고도중시병적겁예방전새。
Objective To observe the efficacy and safety of Bortezomib-based combination chemotherapy in treatment of multiple myeloma ( MM) . Methods A total of 42 patients with MM during March 2010 and June 2013 were selected, including 24 primary patients and 18 relapsed or refractory patients. All the patients underwent Bortezomib-based combination chemotherapy ( Bortezomib + Thalidomide + Dexamethasone + Epirubicin) , and curative effect was summarized. The percentages of MM cells within the bone marrow and changes of serum M protein andβ2-microglobulin before and after treatment were compared, and incidence rate of toxic reaction was also observed. Results Of the 24 pri-mary MM patients, the complete remission (CR) rate was 25%, and total effective rate was 87. 5%;of 18 relapsed or refractory patients, the CR rate was 16. 7%, and total effective rate was 49. 8%, The percentage of MM cells within the bone marrow and levels of serum M protein and β2- microglobulin after treatment were significantly reduced, compared with those before treatment (P<0. 01). Among 42 patients, 27 patients suffered limbs anesthesia and pains;3 patients had chest gas pains;18 patients suffered different degrees of nausea, abdominal distension, constipation, vomiting and dizziness;15 patients had grade 1-2 thrombocytopenia;3 patients had pancytopenia;6 patients had red maculopapular rash;3 patients had shingles. All the symptoms were relieved after symptomatic treatment or lengthened medication dura-tion;1 patient died of pulmonary embolism, 2 patients with cerebral infarction gradually recovered after specific treat-ment. Conclusion The Bortezomib-based combination chemotherapy may achieve good effect and common tolerance in treatment of primary patients, and the main toxic reactions are peripheral neuropathy, so clinicians should pay more atten-tion to preventing embolism complications.