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目的:分析硼替佐米为主化疗方案治疗初始与复发难治多发性骨髓瘤(MM)患者的临床疗效和不良反应。方法:12例患者采用下列3种联合化疗中的一种,VD方案4例【硼替佐米1-1.3mg/m2d1.d4.d8.d11天快速静脉注射+地塞米松注射液40mgd1-4天、d9-12天静注滴注、第17-20天静注滴注(单周),第1-4天静注滴注(双周)】,3周为一疗程。VDT方案6例(硼替佐米1-1.3mg/m2第1.4.8和11天快速静脉注射+地塞米松20mgd1d2d4d5d8d9d11d12+沙利度胺片100-200mgd1-d21天),3周为一疗程。PAD方案2例(硼替佐米硼替佐米1-1.3mg/m2d1.d4.d8.d11天快速静脉注射+多柔比星10mg/d d1-d4天静脉滴注+地塞米松40mg d1-d4天静脉滴注),3周为一疗程。缓解后维持沙利度胺片100-200mg一日一次口服。结果:12例患者中随访(3-18月),CR/NCR 3例,VGPR 5例,PR 2例,MR 0例,NC 1例,PD 1例,有效率(RR=CR/NCR8+VGPR2+PR+MR/12)83.3%。有效的10例患者中,2例在治疗1疗程后即达CR/NCR,3例在治疗2疗程后即达CR/NCR,3例在治疗4疗程后即达CR/NCR,2例在治疗4疗程后即达CR/NCR。12例患者的主要不良反应有胃肠道症状(7/12),周围神经病变5/12)、白细胞减少(3/12),血小板减少(2/12),感染(3/12),1例患者出现血糖增高(1/12),1例患者发生心律失常。结论:硼替佐米联合地塞米松与沙利度胺治疗初始MM起效快,总体反应率及完全缓解率高;该方案用于复发、难治性MM亦有较高治疗反应率,但疗效逊于初始患者。不良反应程度轻微,可控制和预测,总体耐受性良好。
Objective: To analyze the clinical efficacy and adverse reactions of bortezomib-based chemotherapy in the treatment of patients with initial and refractory multiple myeloma (MM). Methods: Twelve patients underwent one of the three combined chemotherapeutic regimens, 4 in the VD regimen (bortezomib 1-1.3 mg / m 2 d1.d4.d8.d11 days of rapid intravenous dexamethasone injection 40 mg d 1-4 d , D9-12 days intravenous drip, 17-20 days intravenous drip (one week), 1-4 days intravenous drip (biweekly)], 3 weeks for a course of treatment. VDT program in 6 cases (bortezomib 1-1.3mg / m2 on days 1.4.8 and 11 rapid intravenous + dexamethasone 20mgd1d2d4d5d8d9d11d12 + thalidomide tablets 100-200mgd1-d21 days) for 3 weeks for a course of treatment. PAD regimen 2 (bortezomib bortezomib 1-1.3mg / m2d1.d4.d8.d11 days rapid intravenous injection + doxorubicin 10mg / d d1-d4 days intravenous infusion + dexamethasone 40mg d1-d4 Day intravenous drip), 3 weeks for a course of treatment. After remission to maintain thalidomide tablets 100-200mg orally once daily. Results: Among the 12 patients, 3 were CR / NCR, 5 were VGPR, 2 were PR, 0 were MR, 1 was NC and 1 was PD. The response rate (RR = CR / NCR8 + VGPR2 + PR + MR / 12) 83.3%. Of the 10 valid patients, 2 achieved CR / NCR after 1 course of treatment, 3 achieved CR / NCR after 2 courses of treatment, 3 achieved CR / NCR after 4 courses of treatment and 2 received treatment 4 after treatment up to CR / NCR. The major adverse reactions in 12 patients were gastrointestinal symptoms (7/12), peripheral neuropathy 5/12), leukopenia (3/12), thrombocytopenia (2/12), infection (3/12), 1 Patients with elevated blood glucose (1/12), 1 patient arrhythmia. Conclusion: Bortezomib combined with dexamethasone and thalidomide are effective in treating initial MM with high overall response rate and complete remission rate. This regimen is also used in relapsed and refractory MM patients with higher response rate, but the efficacy Less than the initial patient. Minor adverse reactions, control and prognosis, overall good.