摘要
本研究探讨不同方案沙利度胺(thalidomide)治疗多发性骨髓瘤(multiple myeloma,MM)的临床疗效和不良反应,寻求沙利度胺一线治疗多发性骨髓瘤的最佳方案,并分析临床疗效与血清TNF-α水平的关系。分别应用高剂量沙利度胺(HD-T)、沙利度胺+VAD化疗(T-VAD)、沙利度胺+MP化疗(T-MP)、沙利度胺+地塞米松(TD)及低剂量沙利度胺(LD-T)等方案治疗85例多发性骨髓瘤,以常规VAD化疗组为对照,观察临床疗效、不良反应、治疗相关死亡率;同时应用双抗体夹心酶联免疫吸附法(ELISA)检测30例沙利度胺治疗的多发性骨髓瘤(15例有效,15例无效)患者治疗前后血清TNF-α水平并与临床疗效比较。结果表明:HD-T、T-VAD、T-MP、TD、LD-T5个组的治疗有效率分别为25.0%、80.0%、71.4%、33.3%、27.3%,其中T-VAD、T-MP组治疗有效率较其他组及常规VAD化疗组显著增高(p<0.05)。显著不良反应(外周神经病变、乏力、腹胀、便秘、皮疹、水肿、白细胞和血小板减少)5个组的发生率为75.0%、30.0%、28.6%、14.3%、9.1%。没有出现Ⅳ级毒性,没有患者出现深静脉血栓,治疗相关死亡率为0%。同时发现,沙利度胺治疗无效组治疗前后血清TNF-α水平分别是(44.7±5.7)pg/ml和(46.3±5.7)pg/ml,两者无显著差异(p>0.05);沙利度胺治疗有效组的治疗后血清TNF-α水平(27.3±6.4)pg/ml,较治疗前(49.2±7.3)pg/ml显著降低(p<0.05)。结论:与常规化疗比较,沙利度胺是治疗多发性骨髓瘤的有效药物,其联合化疗(T-VAD,T-MP)效率高,副作用小,可认为是优选方案。患者血清TNF-α水平是判断沙利度胺治疗多发性骨髓瘤疗效的指标之一,它在多发性骨髓瘤发病中可能具有一定作用。
The study was aimed to investigate the clinical efficacy and adverse reactions of different thalidomide regimens in the treatment of multiple myelorna （MM）, and to explore the relationship between efficacy of thalidomide and serum level of TNF-α in MM patients. The 85 patients with MM were divided into 5 groups according to different combinations of thalidomide. These 5 groups were followling： group with the high dose （HD-T）, group with thalidomide ± VAD chemotherapy （T-VAD）, group with thalidomide ± MP chemotherapy （T-MP）, group with thalidomide plus dexamethasone （TD）, and group with low dose of thalidomide （LD-T）. Except 5 groups mentioned above, the group with conventional VAD chemotherapy was served as the control. Clinical effects, adverse reactions, treatment-related mortality were observed. At the same time, serum levels of TNF-α in 30 cases of MM treated with thalidomide （ 15 cases effective and 15 cases ineffective） before and after treatment were detected by double-antibody sandwich enzymelinked immunosorbent assay （ELISA） and were compared with the clinical efficacy. The results showed that the efficient rate of HD-T, T-VAD, T-MP, TD, LD-T groups were 25.0%, 80.0. %, 71.4%, 33.3%, 27.3% respectively; the efficacy of T-VAD, T-MP groups were significantly higher （p 〈 0.05） than that of other groups and conventional VAD chemotherapy group. The incidence of significant adverse reactions （peripheral neuropathy, fatigue, abdominal distension and constipation, rash, edema, leukocyte and platelet decrease） in 5 groups were 75.0%, 30.0%, 28.6%, 14. 3%, 9.1% respectively, no Ⅳ grade toxicity and deep vein thrombosis were found. The treatment-related mortality was 0%. At the same time, it was found that the serum levels of TNF-α in ineffective group treated with thalidomide were 44.7 ± 5.7 pg/ml and 46.3 ± 4.0 pg/ml before and after thalidomide treatment, and there was no significant difference （p 〉 0.05）. The serum levels of TNF-α （27.3 ± 6.4） pg/ml in the effective group after treatment was sig-nificantly lower than that before treatment （49.2 ± 7.3 ） pg/ml （p 〈 0.05）. It is concluded that compared with conventional chemotherapy, thalidomide is a effective drug for treating MM patients. Thalidomide in combination with chemotherapy （T-VAD, T-MP） may be one better therapeutic regimen with high efficiency and milder advers reactions. Serum level of TNF-α is a indicator for indging effects of thalidomide, and plays a role in the pathogenesis of MM.
出处
《中国实验血液学杂志》
CAS
CSCD
2008年第6期1312-1315,共4页
Journal of Experimental Hematology
