摘要
目的探讨达雷妥尤单抗对复发难治性多发性骨髓瘤(RRMM)患者的治疗效果,及其对T细胞亚群、炎症因子、肿瘤相关因子等指标的影响。方法选取2021年1月—2024年1月在海军第九七一医院、解放军总医院第五医学中心和康复大学青岛中心医院就诊的80例RRMM患者,根据是否应用达雷妥尤单抗分为对照组和试验组,每组40例。对照组接受VRD(硼替佐米、来那度胺和地塞米松)治疗,试验组接受DVD(达雷妥尤单抗、硼替佐米、地塞米松)治疗。对比两组临床疗效、T细胞亚群水平[调节性T淋巴细胞(Treg)、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)]、炎症因子[转化生长因子-β(TGF-β)、干扰素-γ(IFN-γ)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]、肿瘤相关因子[乳酸脱氢酶(LDH)、凋亡抑制蛋白Survivin、血管内皮生长因子(VEGF)、β_(2)-微球蛋白(β2-MG)]、骨髓浆细胞、血红蛋白(Hb)、血清M蛋白、不良反应上的变化。结果试验组总缓解率高于对照组(P<0.05)。试验组治疗前后Treg、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)的差值高于对照组(P<0.05)。试验组治疗前后TGF-β、IFN-γ、IL-6、CRP的差值高于对照组(P<0.05)。试验组治疗前后LDH、Survivin、VEGF、β2-MG的差值高于对照组(P<0.05)。试验组治疗前后骨髓浆细胞、Hb、血清M蛋白的差值高于对照组(P<0.05)。两组患者白细胞减少、血小板减少、乏力、神经性头痛、胃肠道反应及周围神经病变比较,差异均无统计学意义(P>0.05)。结论达雷妥尤单抗联合硼替佐米和地塞米松治疗RRMM能有效改善患者的免疫调节、炎症反应、肿瘤抑制及骨髓功能,同时具有较好的安全性,值得在临床进一步推广应用。
Objective To investigate the therapeutic effects of daratumumab in patients with relapsed and refractory multiple myeloma(RRMM)and its impact on T cell subsets,inflammatory factors,and tumor-associated factors.Methods A total of 80 RRMM patients treated at our hospitals from January 2022 to January 2024 were selected,and they were divided into a control group(n=40)and an experimental group(n=40)based on whether they received daratumumab.The control group received VRD(bortezomib,lenalidomide,and dexamethasone)treatment,while the experimental group received DVD(daratumumab,bortezomib,and dexamethasone)treatment.The clinical efficacy,T-cell subsets[frequencies of regulatory T cells(Treg),CD3^(+)T cells and CD4^(+)T cells,and the ratio of CD4^(+)/CD8^(+)T cells],inflammatory factors[transforming growth factor-β(TGF-β),interferon-γ(IFN-γ),interleukin-6(IL-6),and C-reactive protein(CRP)],tumor-associated factors[lactate dehydrogenase(LDH),survivin,vascular endothelial growth factor(VEGF),andβ_(2)-microglobulin(β2-MG)],frequency of bone marrow plasma cells,levels of hemoglobin(Hb)and serum M protein,and adverse effects were compared between the groups.Results The overall response rate in the experimental group was higher than that in the control group(P<0.05).The differences in frequencies of Treg,CD3^(+)T cells and CD4^(+)T cells and the ratio of CD4^(+)/CD8^(+)T cells before and after treatment in the experimental group were significantly higher than those in the control group(P<0.05).The differences in levels of TGF-β,IFN-γ,IL-6,and CRP before and after treatment in the experimental group were greater than those in the control group(P<0.05).The differences in levels of LDH,survivin,VEGF,andβ2-MG before and after treatment in the experimental group were higher than those in the control group(P<0.05).The differences in the frequency of bone marrow plasma cells and levels of Hb and serum M protein before and after treatment in the experimental group were higher than those in the control group(P<0.05).There was no statistically significant difference between the groups in terms of incidence of leukopenia,thrombocytopenia,fatigue,neuropathic headache,gastrointestinal reactions,and peripheral neuropathy(P>0.05).Conclusions The combination of daratumumab with bortezomib and dexamethasone for treating RRMM effectively improves immune regulation,inflammatory response,tumor suppression,and bone marrow function in patients while maintaining a good safety profile,making it a viable option for further clinical application.
作者
王明辉
于航
陈惠娟
张海燕
Wang Ming-hui;Yu Hang;Chen Hui-juan;Zhang Hai-yan(Department of Hematology,Navy 971 Hospital,Qingdao,Shandong 266071,China;Department of Hematology,The Fifth Medical Center of the People's Liberation Army General Hospital,Beijing 100039,China;Department of Oncology,Navy 971 Hospital,Qingdao,Shandong 266071,China;Department of Oncology,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China)
出处
《中国现代医学杂志》
CAS
2024年第22期72-77,共6页
China Journal of Modern Medicine
基金
山东省医药卫生科技发展计划项目(No:M-2022059)。
