摘要
目的:研究以硼替佐米为主的联合化疗对多发性骨髓瘤(MM)的疗效及其不良反应。方法:回顾性分析52例MM患者,其中42例接受以硼替佐米为主的联合化疗方案:初发MM 31例,复发难治MM 11例;轻链型12例,非轻链型30例;肾功能正常27例,肾功能损害15例;另外10例接受传统型(含长春新碱+蒽环类+地塞米松)化疗方案。比较硼替佐米初治组与传统化疗组,硼替佐米治疗组中轻链型与非轻链型、肾功功能正常者与肾功能损害者的疗效。同时观察42例硼替佐米治疗患者的不良反应。结果:硼替佐米初治组总有效率(ORR)和完全缓解(CR)+非常好的部分缓解(VGPR)率分别为87.10%(27/31)和64.52%(20/31),分别优于传统化疗组的20.00%(2/10)和10.00%(1/10),2组比较均差异有统计学意义(均P<0.05)。硼替佐米治疗组中非轻链型患者的ORR和CR+VGPR率分别为76.67%(23/30)和56.67%(17/30),分别高于轻链型患者的75.00%(9/12)和50.00%(6/12),但2组比较差异无统计学意义;肾功能正常患者的ORR和CR+VGPR率分别为77.78%(21/27)和59.26%(16/27),分别高于肾功能损害者的73.33(11/15)和46.67%(7/15),但2组比较差异亦无统计学意义。接受硼替佐米治疗的42例患者中,不良反应主要为乏力(28.57%、12/42)和周围神经炎(35.71%、15/42)。在给药途径方面,硼替佐米静脉给药组乏力和周围神经炎的发生率,均分别高于硼替佐米皮下注射组(42.86%∶14.28%,52.38%∶19.05%,均P<0.05)。结论:以硼替佐米为主的方案治疗初发MM疗效优于传统化疗方案,肾功能不全患者可以安全使用。硼替佐米的主要不良反应为乏力和周围神经炎,不良反应可以耐受。硼替佐米皮下注射给药可以有效减少不良反应,安全性相对较高。
Objective：To analyze the efficacy and safety of bortezomib-based treatment for multiple myeloma（MM）.Method：Fifty-two MM patients were analyzed retrospectively.Of the MM patients,42 cases were administrated with bortezomib-based combination chemotherapy：31cases were newly diagnosed（NMM）,the other 11 cases were refractory and relapsed;12cases were light-chain type（LC）,30 cases were non-light-chain type（NLC）;15cases accompanied with renal impairment（RI）,the other 27 cases were not accompanied with renal impairment（NRI）.The other 10 patients were administrated with traditional regimen（TR）（including vincristine,anthracycline and dexamethasone）chemotherapy.Then comparative analyses were conducted among the efficacy of NMM group and TR group,LC group and NLC group,RI group and NRI group.In combination,the safeties of bortezomib were evaluated in 42 MM patients.Result：The ORR and CR＋VGPR of 31 NMM patients in the bortezomibbased chemotherapy group were 87.10%（27/31）and 64.52%（20/31）respectively,significantly higher than those of 20.00%（2/10）,10.00%（1/10）in TR group（P〈0.05）.The ORR and CR＋VGPR in NLC group were76.67%（23/30）and 56.67%（17/30）respectively,higher than those of 75.00%（9/12）and 50.00%（6/12）in LC group,however,there were no significant differences in ORR and CR ＋ VGPR between these two groups.The ORR and CR＋VGPR in NRI group were 77.78%（21/27）and 59.26%（16/27）respectively,higher than those of 73.33%（11/15）and 46.67%（7/15）in RI group,however,there were no significant differences in ORR and CR＋VGPR between these two groups.Among 42 patients who received the bortezomib-based treatment,the incidence rate of fatigue was 28.57%（12/42）and peripheral neuritis was 35.71%（15/42）.In terms of routes of administration,the incidence rates of fatigue and peripheral neuritis in intravenous injection group were significantly higher than those in subcutaneous injection group（42.86% vs.14.28%,52.38% vs.19.05%,P〈0.05）.Conclusion：Compared with traditional chemotherapy,bortezomib-based chemotherapy has better clinical effect to treat the newly diagnosed MM patients.This regimen is also safe in the patients with renal impairment.The main adverse events of bortezomib are fatigue and peripheral neuritis,but the adverse events can be tolerant in most patients.Subcutaneous injection can be effective in reducing the incidence of peripheral neuritis with a relatively high safety.
出处
《临床血液学杂志》
CAS
2016年第4期563-566,570,共5页
Journal of Clinical Hematology
