CAJ | 학술논문

目的：观察硼替佐米联合改良 VAD 方案（PVAD）治疗多发性骨髓瘤（multiple myeloma）的疗效和安全性。方法：共有52例 MM患者接受了2～8个疗程 PVAD 方案化疗。PVAD 方案：硼替佐米（万珂）1．3mg／m2，3秒内快速注射，d1，4，8，11；长春瑞滨10mg／d 静滴，d1～4；吡柔比星10mg／d 静滴，d1～4；地塞米松20mg／d 静滴，d1～4。每28天为1个疗程，观察疗效和不良反应。结果：总体反应率[完全缓解（CR）＋接近完全缓解（nCR）＋部分缓解（PR）＋轻微反应（MR）]为92．3％（48／52），治疗有效率（CR ＋PR）为88．5％（46／52）。其中在 PVAD 方案治疗前接受过 VAD 方案治疗的21例患者中，18例有效，治疗有效率（CR ＋PR）为85．7％（18／21）。最常见的血液系统不良反应包括白细胞减少、贫血、血小板减少。非血液系统不良反应主要为乏力、外周神经病变、腹胀／便秘等消化道症状、带状疱疹、呼吸道感染、血栓形成等，经对症处理后均可缓解或恢复。结论：PVAD 方案在初发或难治复发的多发性骨髓瘤中均有较好疗效，且具有良好的安全性和耐受性。优于单用硼替佐米或单用 VAD 方案。
목적：관찰붕체좌미연합개량 VAD 방안（PVAD）치료다발성골수류（multiple myeloma）적료효화안전성。방법：공유52례 MM환자접수료2～8개료정 PVAD 방안화료。PVAD 방안：붕체좌미（만가）1．3mg／m2，3초내쾌속주사，d1，4，8，11；장춘서빈10mg／d 정적，d1～4；필유비성10mg／d 정적，d1～4；지새미송20mg／d 정적，d1～4。매28천위1개료정，관찰료효화불량반응。결과：총체반응솔[완전완해（CR）＋접근완전완해（nCR）＋부분완해（PR）＋경미반응（MR）]위92．3％（48／52），치료유효솔（CR ＋PR）위88．5％（46／52）。기중재 PVAD 방안치료전접수과 VAD 방안치료적21례환자중，18례유효，치료유효솔（CR ＋PR）위85．7％（18／21）。최상견적혈액계통불량반응포괄백세포감소、빈혈、혈소판감소。비혈액계통불량반응주요위핍력、외주신경병변、복창／편비등소화도증상、대상포진、호흡도감염、혈전형성등，경대증처리후균가완해혹회복。결론：PVAD 방안재초발혹난치복발적다발성골수류중균유교호료효，차구유량호적안전성화내수성。우우단용붕체좌미혹단용 VAD 방안。
Objective:To observe the therapeutic effect and safety of bortizomib combined with modified VAD reg-imen in treatment of patients with multiple myeloma(MM).Methods:All of the 52 patients diagnosed of MM were treated with bortizomib combined with modified VAD regimen for two to eight courses.The regimen was consisted of bortizomib,1.3mg/m2 by jet injection,d1,4,8,11 ,vinorelbine,10mg/d,by intravenous continuous infusion,d1 ~4 ,piraru-bicin,10mg/d,by intravenous continuous infusion,d1 ~4 ,dexamethasone,20mg/d,by intravenous continuous infusion, d1 ~4 .Twenty -eight days was as one course of treatment.Results:The overall reaction rate(CR +nCR +PR +MR) was 92.3 %(48 /52),and the overall response rate(CR +PR)was 88.5 %(46 /52).Among them,21 patients ever accepted sole modified VAD regimen,and the overall response rate was 85.7 %(18 /21).The main hematologic tox-icities were leucocytopenia,anemia and thrombocytopenia.Nonhematologic toxicities were included anergy,peripheral neuropathy,abdominal distension/constipation,herpes zoster,respiratory tract infections,thrombosis etc.They were all well tolerated.Conclusion:The regimen of bortizomib combined with modified VAD is effective and safe for newlydiagnosed or refractory and relapsed MM patients,and the results are better than the single rigmen of bortizomib or modified VAD.