肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2013年
9期
602-604,608
,共4页
木合拜尔·阿布都尔%买买提力·依马木%王晓敏
木閤拜爾·阿佈都爾%買買提力·依馬木%王曉敏
목합배이·아포도이%매매제력·의마목%왕효민
多发性骨髓瘤,轻链型%硼替佐米%肾功能不全%治疗
多髮性骨髓瘤,輕鏈型%硼替佐米%腎功能不全%治療
다발성골수류,경련형%붕체좌미%신공능불전%치료
Multiple myeloma,light-chain%Bortezomib%Renal insufficiency%Treatment
目的 分析和比较硼替佐米+地塞米松(BD)方案和长春地辛+表柔比星+地塞米松(VAD)方案治疗轻链型多发性骨髓瘤(MM)患者的疗效及不良反应.方法 回顾性分析16例临床资料和随访记录完整的轻链型MM患者的病例资料,7例患者采用BD方案化疗,9例患者采用VAD方案化疗,分析比较BD和VAD两种化疗方案治疗轻链型MM患者的疗效及不良反应.结果 中位随访时间为24个月(2 ～ 76个月),BD方案组总反应率(85.7％,6/7)高于VAD方案组(55.6％,5/9),但两组差异无统计学意义(x2=1.667,P=0.308).BD方案组完全缓解(CR)+接近完全缓解(nCR)率为42.9％(3/7),高于VAD组0.0％(0/9)(x2=4.747,P=0.029).BD方案组合并肾功能不全的5例患者总反应率(80.0％,4/5)高于VAD方案组合并肾功能不全的7例患者(57.1％,4/7),但两组差异无统计学意义(x2=0.686,P=0.576).BD方案组最常见的不良反应依次是血液学毒性合并感染(42.8％,3/7)、周围神经病变(28.6％,2/7)、胃肠道反应(14.3％,1/7),大部分为1～2级,经对症治疗后可缓解.VAD方案组最常见不良反应依次是血液学毒性合并肺部感染(44.4％,4/9)、胃肠道反应(33.3％,3/9)、脱发(22.2％,2/9)等.结论 轻链型MM对治疗反应差,预后不佳,但BD方案明显提高轻链型MM患者的总有效率,虽然总有效率与VAD方案无明显差异,但达CR+ nCR率明显高于VAD方案化疗者,不良反应可以耐受,且合并肾功能不全的患者也可安全应用.
目的 分析和比較硼替佐米+地塞米鬆(BD)方案和長春地辛+錶柔比星+地塞米鬆(VAD)方案治療輕鏈型多髮性骨髓瘤(MM)患者的療效及不良反應.方法 迴顧性分析16例臨床資料和隨訪記錄完整的輕鏈型MM患者的病例資料,7例患者採用BD方案化療,9例患者採用VAD方案化療,分析比較BD和VAD兩種化療方案治療輕鏈型MM患者的療效及不良反應.結果 中位隨訪時間為24箇月(2 ～ 76箇月),BD方案組總反應率(85.7％,6/7)高于VAD方案組(55.6％,5/9),但兩組差異無統計學意義(x2=1.667,P=0.308).BD方案組完全緩解(CR)+接近完全緩解(nCR)率為42.9％(3/7),高于VAD組0.0％(0/9)(x2=4.747,P=0.029).BD方案組閤併腎功能不全的5例患者總反應率(80.0％,4/5)高于VAD方案組閤併腎功能不全的7例患者(57.1％,4/7),但兩組差異無統計學意義(x2=0.686,P=0.576).BD方案組最常見的不良反應依次是血液學毒性閤併感染(42.8％,3/7)、週圍神經病變(28.6％,2/7)、胃腸道反應(14.3％,1/7),大部分為1～2級,經對癥治療後可緩解.VAD方案組最常見不良反應依次是血液學毒性閤併肺部感染(44.4％,4/9)、胃腸道反應(33.3％,3/9)、脫髮(22.2％,2/9)等.結論 輕鏈型MM對治療反應差,預後不佳,但BD方案明顯提高輕鏈型MM患者的總有效率,雖然總有效率與VAD方案無明顯差異,但達CR+ nCR率明顯高于VAD方案化療者,不良反應可以耐受,且閤併腎功能不全的患者也可安全應用.
목적 분석화비교붕체좌미+지새미송(BD)방안화장춘지신+표유비성+지새미송(VAD)방안치료경련형다발성골수류(MM)환자적료효급불량반응.방법 회고성분석16례림상자료화수방기록완정적경련형MM환자적병례자료,7례환자채용BD방안화료,9례환자채용VAD방안화료,분석비교BD화VAD량충화료방안치료경련형MM환자적료효급불량반응.결과 중위수방시간위24개월(2 ～ 76개월),BD방안조총반응솔(85.7％,6/7)고우VAD방안조(55.6％,5/9),단량조차이무통계학의의(x2=1.667,P=0.308).BD방안조완전완해(CR)+접근완전완해(nCR)솔위42.9％(3/7),고우VAD조0.0％(0/9)(x2=4.747,P=0.029).BD방안조합병신공능불전적5례환자총반응솔(80.0％,4/5)고우VAD방안조합병신공능불전적7례환자(57.1％,4/7),단량조차이무통계학의의(x2=0.686,P=0.576).BD방안조최상견적불량반응의차시혈액학독성합병감염(42.8％,3/7)、주위신경병변(28.6％,2/7)、위장도반응(14.3％,1/7),대부분위1～2급,경대증치료후가완해.VAD방안조최상견불량반응의차시혈액학독성합병폐부감염(44.4％,4/9)、위장도반응(33.3％,3/9)、탈발(22.2％,2/9)등.결론 경련형MM대치료반응차,예후불가,단BD방안명현제고경련형MM환자적총유효솔,수연총유효솔여VAD방안무명현차이,단체CR+ nCR솔명현고우VAD방안화료자,불량반응가이내수,차합병신공능불전적환자야가안전응용.
Objective To comparatively analyze the efficiency and toxicity of BD (bortezomib plus dexamethasone) regimen and VAD (vincristine combined with pirarubicin and dexamethasone) regimen for patients with light-chain multiple myeloma (MM).Methods Retrospective investigation of 16 cases of patients with light-chain MM.7 patients were receiving BD regimen and 9 patients were receiving VAD regimen.Results With a median follow-up of 24 months (2-76 months) in BD group,the total response rate (85.7 ％,6/7) was higher than VAD group (55.6 ％,5/9),with no statistical significance (x2 =1.667,P =0.308).But the CR+nCR rate of the BD group (42.9 ％,3/7) was significantly higher than VAD group (0.0 ％,0/9) (x2 =4.747,P =0.029).5 patients with renal dysfunction in BD group,and that of total response rate (80.0 ％,4/5) was higher than VAD group (57.1％,4/7),but with no statistical significance (x2 =0.686,P =0.576).Main adverse effects in BD group were hematologic toxicity combined with infection (42.8 ％,3/7),peripheral neuropathy (28.6 ％,2/7) and digestive reaction (14.3 ％,1/7).These adverse effects were mild (grade 1-2) and could be relieved by symptomatic treatments.The most common adverse events in VAD group were hematologic toxicity combined with infection (44.4 ％,4/9),digestive reaction (33.3 ％,3/9) and hair loss (22.2 ％,2/9).Conclusion Light chain MM has an aggressive clinical course with poor response to treatment and unfavorable prognosis,but BD regimen has significantly improve the overall reaction rate of light chain type MM.BD has higher CR+nCR rate compared with VAD and can be tolerant in most patients.BD is safe in patients with renal inadequacy.
