CAJ | 학술논문

目的研究硼替佐米为主的化疗方案治疗多发性骨髓瘤患者的临床疗效及安全性.方法 80例患者采用硼替佐米联合地塞米松或硼替佐米联合地塞米松及阿霉素方案化疗.其中16例患者化疗后联合自体或异基因造血干细胞移植巩固治疗.评价其疗效及不良反应,并进行生存分析.结果 80例患者中位年龄57(25～78)岁,总反应率80％,完全缓解(CR)率46.3％.中位随访25(1～81)个月,患者1年及2年总生存(0S)率分别为81.4％和72.9％,1年及2年无进展生存(PFS)率分别为76.0％和62.5％.其中16例患者化疗后序贯造血干细胞移植治疗,序贯移植组及单纯化疗组患者2年OS率分别为100.0％和66.0％(P=0.029),2年PFS率分别为73.9％和58.7％(P=0.447).单因素分析中,影响OS的因素包括Durie-Salmon分期(肾功能是否异常)(P=0.010)、国际分期系统分期(P=0.009)、用药后是否达CR及非常好的部分缓解(VGPR)(P=0.002)、是否序贯造血干细胞移植(P=0.029);影响PFS的因素包括性别(P=0.026)及是否存在髓外病变(P=o.025).多因素分析中,延长OS的因素为最佳疗效达CR及VGPR (P=0.001)、Durie-Salmon分期A组(无肾功能异常)(P=0.006)及序贯造血干细胞移植治疗(P=0.052);延长PFS的因素为男性(P=0.020)及不伴髓外病变(P=0.030).结论硼替佐米为主的化疗可有效地治疗初治及难治复发的多发性骨髓瘤患者,联合自体或异基因造血干细胞移植可以进一步提高患者OS率.
목적 연구붕체좌미위주적화료방안치료다발성골수류환자적림상료효급안전성.방법 80례환자채용붕체좌미연합지새미송혹붕체좌미연합지새미송급아매소방안화료.기중16례환자화료후연합자체혹이기인조혈간세포이식공고치료.평개기료효급불량반응,병진행생존분석.결과 80례환자중위년령57(25～78)세,총반응솔80％,완전완해(CR)솔46.3％.중위수방25(1～81)개월,환자1년급2년총생존(0S)솔분별위81.4％화72.9％,1년급2년무진전생존(PFS)솔분별위76.0％화62.5％.기중16례환자화료후서관조혈간세포이식치료,서관이식조급단순화료조환자2년OS솔분별위100.0％화66.0％(P=0.029),2년PFS솔분별위73.9％화58.7％(P=0.447).단인소분석중,영향OS적인소포괄Durie-Salmon분기(신공능시부이상)(P=0.010)、국제분기계통분기(P=0.009)、용약후시부체CR급비상호적부분완해(VGPR)(P=0.002)、시부서관조혈간세포이식(P=0.029);영향PFS적인소포괄성별(P=0.026)급시부존재수외병변(P=o.025).다인소분석중,연장OS적인소위최가료효체CR급VGPR (P=0.001)、Durie-Salmon분기A조(무신공능이상)(P=0.006)급서관조혈간세포이식치료(P=0.052);연장PFS적인소위남성(P=0.020)급불반수외병변(P=0.030).결론 붕체좌미위주적화료가유효지치료초치급난치복발적다발성골수류환자,연합자체혹이기인조혈간세포이식가이진일보제고환자OS솔.
Objective To evaluate the efficacy and safety of bortezomib-based chemotherapy for 80 patients with multiple myeloma (MM).Methods A total of 80 cases with a median age of 57 (range:25-78) years were enrolled in the study.Bortezomib-based regimens included VD (bortezomib and dexamethasone) and PAD (bortezomib,doxorubicin and dexamethasone).16 of the 80 patients received autologous or allo-hematopoietic stem cell transplantation (HSCT).Results The overall response (OR)rate was 80％,including a complete response (CR) of 46.3％.After a median follow-up of 25 months,the 1-year and 2-year overall survival (OS) was 81.4％ and 72.9％,and the 2-year progression-free survival (PFS) was 76％ and 62.5％,respectively.The 2-year OS and PFS were 100％ and 73.9 ％ in patients with HSCT,while both were 66％ (P=0.029) and 58.7％ (P=0.447) in patients without HSCT.In univariate analysis,Durie-Salmon group,ISS stage,CR and very good partial response (VGPR),and HSCT were prognostic factors for OS.Gender and extramedullary plasmacytomas were important prognostic factors for PFS.Multivariate analysis by Cox regression revealed that CR and VGPR,Durie-Salmon group A,and HSCT were prognostic factors for better OS; while male and patients without extramedullary plasmacytomas were prognostic factors for longer PFS.Conclusion MM patients could benefit from bortezomib-based chemotherapy with satisfactory efficacy and safety.HSCT could improve the OS for young MM patients.