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【目的】探讨沙利度胺联合V AD方案治疗老年多发性骨髓瘤的疗效。【方法】收集老年多发性骨髓瘤患者46例，依据治疗方案不同分为两组，每组23例，观察组采用沙利度胺联合V AD方案治疗，对照组采用沙利度胺联合地塞米松治疗，治疗3个疗程后比较两组疗效及不良反应。【结果】观察组有效率为73．4％（17／23），显著高于对照组52．2％（12／23），差异有统计学意义（ P ＜0．05）；观察组血红蛋白、血清M蛋白和卡氏评分与对照组比较有显著差异（P ＜0．05）；两组患者便秘、皮疹、血糖升高、骨髓抑制等方面的不良反应比较无明显差异（P＞0．05），但观察组头晕，嗜睡等不良反应显著高于对照组（ P ＜0．05）。【结论】沙利度胺联合 VAD方案治疗多发性骨髓瘤疗效满意，不良反应无明显增加，值得临床推广应用。“,”[Objective]To analyze the clinical efficacy and safety of thalidomide plus dexamethasone or VAD in the treatment of senile multiple myeloma .[Methods] A total of 46 inpatients during September 2006 to October 2014 were randomly selected and equally divided into 2 groups of control and observation .The control group re‐ceived thalidomide plus dexamethasone while the observation group thalidomide plus VAD .After 3 courses of treatment ,clinical efficacy ,clinical indices and adverse events between 2 groups were compared .[Results] After treatments ,the effective rate was 52 .2% in control group versus 73 .4% in treatment group ( P<0 .05) .Signifi‐cant inter‐group differences existed in the serum levels of hemoglobin ,M protein and Karnofsky score ( P <0 .05) .No significant differences existed in the occurrence of constipation ,rush ,hyperglycemia or myelosuppres‐sion .However ,the occurrences of dizziness and drowsiness were higher in control group than those in observation group ( P <0 .05) .[Conclusion] The clinical efficacy of thalidomide plus VAD is higher than that of thalidomide plus dexamethasone in the treatment of senile multiple myeloma .And there is no significant increase of adverse e‐vents .