上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (12): 1793-.doi: 10.3969/j.issn.1674-8115.2011.12.031

• 短篇论著 • 上一篇    

硼替佐米为主的化疗方案对改善初治多发性骨髓瘤患者生存的作用

赵冰冰1,2, 王 焰1, 糜坚青1, 沈志祥1, 陈 瑜1, 陈秋生1, 徐 岚1, 吕银祥2   

  1. 1.上海交通大学 医学院附属瑞金医院血液科, 上海200025； 2.浙江省新昌县人民医院血液科, 浙江 310025
  • 出版日期:2011-12-28 发布日期:2012-01-04
  • 作者简介:赵冰冰（1980—）, 女, 主治医师, 学士；电子信箱: zjocclusion@126.com。

Improvement of survival in patients with newly diagnosed multiple myeloma treated by Bortezomib based chemotherapy

ZHAO Bing-bing1,2, WANG Yan1, MI Jian-qing1, SHEN Zhi-xiang1, CHEN Yu1, CHEN Qiu-sheng1, XU Lan1, LV Yin-xiang2   

  1. 1.Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China；2.Department of Hematology, Xinchang County People's Hospital, Zhejiang 310025, China
  • Online:2011-12-28 Published:2012-01-04

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摘要：

目的 评估以硼替佐米为主的化疗方案对初发多发性骨髓瘤患者的疗效，并分析其影响生存的预后因素。方法 38例初治骨髓瘤患者接受以硼替佐米为主的联合化疗，联合化疗药物分别为马法兰+泼尼松、地塞米松、地塞米松+环磷酰胺或地塞米松+阿霉素。每3~4周1个疗程，疗程的第1、4、8、11天给予硼替佐米1.3 mg/m2静脉注射。患者至少接受2~10个疗程的治疗。采用欧洲血液和骨髓移植工作组标准评价疗效，按照国际癌症协会毒副反应共同术语3.0版标准判断不良反应。采用Log-rank检验和Cox回归模型进行预后分析。结果 患者中位随访期为19个月；总反应率（完全缓解+非常好的部分缓解+部分缓解）为86.84%；中位无进展生存时间19.47个月，中位生存期39.17个月。单因素和多因素分析均显示，治疗后是否获得完全缓解或非常好的部分缓解是影响患者生存的因素，而M蛋白分型、年龄、Duriesalmon分期、高血清肌酐、低血红蛋白、低白蛋白、高β2微球蛋白、高乳酸脱氢酶均与预后无关。治疗中主要不良反应有胃肠道症状、白细胞减少、血小板减少、周围神经病变以及乏力等。结论 硼替佐米联合化疗治疗初发骨髓瘤，患者的耐受好，疗效显著，可消除传统认为的不良预后因素对生存的影响。

关键词: 多发性骨髓瘤, 硼替佐米, 疗效, 预后

Abstract:

Objective To evaluate the curative effect of Bortezomib based chemotherapy in treatment of patients with newly diagnosed multiple myeloma, and explore the prognositic factors. Methods Thirty-eight patients with newly diagnosed multiple myeloma received Bortezomib based chemotherapy, and the drugs used in chemotherapy included Melphalan+Prednisone, Dexamethasone, Dexmethasone+Cyclophosphamide or Dexamethasone+Adriamycin. Each course of treatment lasted for 3 to 4 weeks, and intravenous injection of 1.3 mg/m2 Bortezomib was performed on the 1st, 4th, 8th and 11th day of each course. Patients were managed with 2 to 10 courses. Response to Bortezommib was assessed according to the criteria of European Group for Blood and Marrow Transplantation, and adverse events were evaluated according to the criteria of National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0. The prognosis factors were analysed by Log-rank test and COX regression model. Results The median duration of follow-up was 19 months. The overall response rate (complete remission+very good partial remission+partial remission) was 86.84%. The median progression-free survival was 19.47 months, and the median overall survival was 39.17 months. Univariate analysis and multivariate analysis revealed that complete remission and very good partial remission after treatment were prognostic factors, while M protein typing, age, Durie-salmon staging, high serum creatinine, low hemoglobin, low albumin, high β2 microglobulin and high lactate dehydrogenase were not related to prognosis. The major adverse events during treatment were gastrointestinal sympotoms, leukocytopenia, thrombocytopenia, peripheral neuropathy and fatigue. Conclusion Bortezomib based chemotherapy is well tolerated and effective in treatment of patients with newly diagnosed multiple myeloma, which overcomes the poor prognosis conferred by traditional prognosis factors.

Key words: multiple myeloma, Bortezomib, curative effect, prognosis