摘要
目的探讨以硼替佐米为主的化疗方案治疗初治多发性骨髓瘤(MM)的临床疗效。方法回顾性分析2013年1月至2016年1月收治的66例初治MM患者的临床资料,按照接受化疗方案不同分为BAD组(硼替佐米+阿霉素+地塞米松)22例,BCD组(硼替佐米+环磷酰胺+地塞米松)14例和BRD(硼替佐米+来那度胺+地塞米松)组30例。对三组短期疗效进行分析,记录总生存(OS)和无进展生存(PFS),根据NCI常见不良反应事件评价标准(CTCAE)第4版评估治疗期间的毒副反应。结果三组患者总体发生率(ORR)比较无统计学差异(P>0.05)。所有患者均接受至少4个疗程化疗,ORR 71.2%,随着疗程数增加,患者完全缓解(CR)率与ORR率逐渐增加,接受5～7个疗程患者ORR 79.6%,接受8个以上疗程患者ORR为88.9%,三种不同疗程时的ORR率比较差异有统计学意义(P<0.01),以接受8个以上疗程患者ORR最高。本组66例患者随访时间8～61个月,截止随访时间为2018年1月31日,中位随访时间为21个月。全部患者中位OS 48个月(95%CI:20.47～101.53),中位PFS为26个月(95%CI:27.03～38.92),三组OS(P=0.996)和PFS(P=0.956)比较无统计学差异。所有患者不良反应症状较轻。三组间血液学毒性及消化道反应比较有统计学差异(P均<0.01),以BAD组最高。结论以硼替佐米为基础的BAD、BCD和BRD化疗方案对MM具有良好疗效,且4个月以上疗程临床疗效较显著,三种方案在OS及PFS未见统计学差异。在毒副作用评估方面BAD方案血液学及消化道毒副作用最高。
Objective To investigate the clinical efficacy of bortezomib-based chemotherapy regimens in the newly treatment of multiple myeloma(MM).Methods The clinical data of 66 MM patients with newly treated admitted to hospital from January 2013 to January 2016 were retrospectively analyzed.According to different chemotherapy regimens,the patients were divided into BAD group(bortezomib+adriamycin+dexamethasone,n=22),BCD group(bortezomib+cyclophosphamide+dexamethasone,n=14)and BRD group(bortezomib+lenalidomide+dexamethasone,n=30).The short-term curative effects of three regimens were observed,and the overall survival(OS)and progression-free survival(PFS)were recorded.Toxicity side effects during treatment were assessed according to the fourth edition of NCI-Common Terminology Criteria for Adverse Events(CTCAE).Results There was no significant difference in overall response rate(ORR)among three groups(P>0.05).All patients received at least 4 courses of chemotherapy,and ORR was 71.2%.With the increase in number of chemotherapy courses,complete remission(CR)and ORR of patients increased gradually.ORR was 79.6%in patients receiving 5-7 courses and 88.9%in patients receiving more than 8 courses.There were significant differences in ORR rates among three different courses of treatment(P<0.01),and ORR of patients receiving more than 8 courses was highest.The follow-up period of 66 patients ranged from 8 to 61 months,with a mean follow-up of 21 months.The deadline for follow-up was January 31,2018.The median OS and PFS were 48 months(95%CI:20.47-101.53)and 26 months(95%CI:27.03-38.92)respectively.There were no significant differences in OS(P=0.996)and PFS(P=0.956)among three groups.The adverse reactions were mild in all patients.The incidences of hematological toxicity and digestive tract reaction had statistical differences between three groups(all P<0.01),and the highest was in BAD group.Conclusions Bortezomib-based BAD,BCD and BRD chemotherapy regimens have a good effect on MM,and the clinical efficacy is more obvious in patients receiving treatment for more than four months.There are no statistical differences in OS and PFS among three therapy regimens for MM patients.The hematological and gastrointestinal adverse reactions of BAD regimen are highest.
作者
张婷
马永超
杨莉莉
师锦宁
ZHANG Ting;MA Yong-chao;YANG Li-li;SHI Jin-ning(Department of Hematology,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing,Jiangsu 211100,China)
出处
《中国临床研究》
CAS
2019年第4期504-508,共5页
Chinese Journal of Clinical Research
基金
南京市医学科技发展项目(YKK15199)~~
