中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
11期
1643-1647
,共5页
吴国林%汪晓虹%宋浩%徐强%胡茂贵%曹琳琳%范丹丹%周晨阳%王翠翠
吳國林%汪曉虹%宋浩%徐彊%鬍茂貴%曹琳琳%範丹丹%週晨暘%王翠翠
오국림%왕효홍%송호%서강%호무귀%조림림%범단단%주신양%왕취취
多发性骨髓瘤%硼替佐米%治疗效果
多髮性骨髓瘤%硼替佐米%治療效果
다발성골수류%붕체좌미%치료효과
Multiple myeloma%Bortezomib%Treatment outcome
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.
目的 觀察硼替佐米為主的化療方案治療複髮難治性多髮性骨髓瘤的近期療效與安全性.方法 對2009年1月至2012年12月採用硼替佐米聯閤化療方案治療45例複髮難治性多髮性骨髓瘤患者的臨床資料進行迴顧性分析.患者中男25例,女20例,年齡37～ 78歲,平均(57±2)歲.其中15例接受PAD(硼替佐米、阿黴素、地塞米鬆)方案,15例接受PCD(硼替佐米、環燐酰胺、地塞米鬆)方案,8例接受PD(硼替佐米、地塞米鬆)方案,7例接受PDT(硼替佐米、地塞米鬆、沙利度胺)方案.按照歐洲骨髓移植協作組標準評價療效(EBMT),世界衛生組織(WHO)標準判斷不良反應.結果 隨訪25(5 ～35)箇月,採用PAD方案治療的15例患者有效率93.3％,其中完全緩解+接近完全緩解7例、非常好的部分緩解3例、部分緩解2例、輕微反應2例、疾病穩定1例.採用PCD方案治療15例患者有效率93.3％(14/15),其中完全緩解+接近完全緩解7例、非常好的部分緩解3例、部分緩解3例、輕微反應1例、疾病穩定1例.採用PAD與PCD方案有效率差異無統計學意義(P＞0.05).採用PD方案治療8例患者有效率75.0％(6/8),其中完全緩解+接近完全緩解3例、非常好的部分緩解1例、部分緩解1例、輕微反應1例、疾病穩定1例、疾病進展1例.採用PDT方案治療7例患者有效率85.7％ (6/7),其中完全緩解+接近完全緩解2例、非常好的部分緩解1例、部分緩解1例、輕微反應1例、疾病穩定1例、疾病進展1例.採用PD與PTD方案2組臨床療效差異無統計學意義(P＞0.05).22例患者齣現外週神經病變,主要錶現為肢耑痳木、感覺減退,其中15例為Ⅰ～Ⅱ級.6例因同時使用硼替佐米、沙利度胺齣現肢耑痳木,停用沙利度胺後臨床癥狀逐漸緩解,1例為Ⅲ級.主要不良反應為週圍神經病變、胃腸道癥狀、帶狀皰疹及感染、血液繫統不良反應、乏力、脫髮.但通過對癥治療及調整藥物劑量或停藥後均能改善.結論 硼替佐米為主的方案治療複髮難治性多髮性骨髓瘤,有較高的治療反應率,不良反應可有效得到控製,大多數患者總體耐受性好,但遠期療效有待進一步臨床觀察.
목적 관찰붕체좌미위주적화료방안치료복발난치성다발성골수류적근기료효여안전성.방법 대2009년1월지2012년12월채용붕체좌미연합화료방안치료45례복발난치성다발성골수류환자적림상자료진행회고성분석.환자중남25례,녀20례,년령37～ 78세,평균(57±2)세.기중15례접수PAD(붕체좌미、아매소、지새미송)방안,15례접수PCD(붕체좌미、배린선알、지새미송)방안,8례접수PD(붕체좌미、지새미송)방안,7례접수PDT(붕체좌미、지새미송、사리도알)방안.안조구주골수이식협작조표준평개료효(EBMT),세계위생조직(WHO)표준판단불량반응.결과 수방25(5 ～35)개월,채용PAD방안치료적15례환자유효솔93.3％,기중완전완해+접근완전완해7례、비상호적부분완해3례、부분완해2례、경미반응2례、질병은정1례.채용PCD방안치료15례환자유효솔93.3％(14/15),기중완전완해+접근완전완해7례、비상호적부분완해3례、부분완해3례、경미반응1례、질병은정1례.채용PAD여PCD방안유효솔차이무통계학의의(P＞0.05).채용PD방안치료8례환자유효솔75.0％(6/8),기중완전완해+접근완전완해3례、비상호적부분완해1례、부분완해1례、경미반응1례、질병은정1례、질병진전1례.채용PDT방안치료7례환자유효솔85.7％ (6/7),기중완전완해+접근완전완해2례、비상호적부분완해1례、부분완해1례、경미반응1례、질병은정1례、질병진전1례.채용PD여PTD방안2조림상료효차이무통계학의의(P＞0.05).22례환자출현외주신경병변,주요표현위지단마목、감각감퇴,기중15례위Ⅰ～Ⅱ급.6례인동시사용붕체좌미、사리도알출현지단마목,정용사리도알후림상증상축점완해,1례위Ⅲ급.주요불량반응위주위신경병변、위장도증상、대상포진급감염、혈액계통불량반응、핍력、탈발.단통과대증치료급조정약물제량혹정약후균능개선.결론 붕체좌미위주적방안치료복발난치성다발성골수류,유교고적치료반응솔,불량반응가유효득도공제,대다수환자총체내수성호,단원기료효유대진일보림상관찰.
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.
