摘要
目的观察硼替佐米+脂质体阿霉素+地塞米松(PAD)方案治疗多发性骨髓瘤(MM)的疗效和安全性。方法共有13例MM患者接受了1～3个疗程的PAD方案(硼替佐米1.3 mg/m2,第1、4、8、11天,快速静脉注射;脂质体阿霉素40mg/m2,第4天,静脉滴注;地塞米松20 mg/d,静脉滴注,第1～4天,每4周1个疗程)化疗。其中,既往应用硼替佐米联合地塞米松(VD)方案疗效欠佳或对VD方案原发耐药者6例,VD方案序贯自体造血干细胞移植(ASCT)后复发患者5例,新诊断伴髓外浸润患者1例,髓外复发患者1例。结果总反应率〔完全缓解(CR)+接近完全缓解(nCR)+部分缓解(PR)+轻微反应(MR)〕为92.3%,≥PR以上疗效为69.2%。其中,6例对VD方案疗效不佳或原发耐药的患者中有5例有效;PAD方案对髓外浸润的患者起效较快,但维持时间较短;血液系统不良反应包括白细胞(WBC)减少10例(83.3%),中性粒细胞减少9例(75%),血小板减少8(66.7%)例。其中有4例(33.3%)出现IV级中性粒细胞减少,粒缺持续时间为1～6(中位时间为3.5)天。3例(25%)患者出现IV级血小板减少,需要输注血小板1～2治疗单位。结论 PAD方案对VD方案治疗效果欠佳或原发耐药的MM患者有很好的疗效,对VD序贯ASCT后复发患者也有一定疗效,对于伴有髓外浸润患者起效较快,但维持时间较短。
Objective To study the efficacy and safty of PAD regimen（Bortezomib plus liposome doxorubicin plus Dexamethasone）for multiple myeloma.Methods Thirteen cases with multiple myeloma received one to three cycles of PAD regimen（Bortezomib 1.3 mg/m2 on the 1st,4th,8th and 11th day,iv;liposome doxorubicin 40 mg/m2 on the 4th day,iv gtt;Dexamethasone 20 mg from 1 to 4 days,1 course per 4 weeks）.Six patients failed in VD regimen（Bortezomib plus Dexamethasone）and 5 patients relapsed after VD regimen and ASCT.Two patients were accompanied by extramedullary infiltration and extramedullary relapse respectively.Results The total response rate [total response rate=complete remission（CR）rate＋near complete remission（nCR）rate＋partial remission（PR）rate＋minimal response（MR）rate] of PAD regimen was 92.3%.The rate of CR＋nCR＋PR was 69.2%.PAD regimen was effective in 5 of the 6 patients who failed in VD regimen,and had rapid onset but short duration on patients with extramedullary infiltration.Hematological adverse events included decrease in WBC 10 cases（83.3%）,neutropenia in 8 cases（75%）and thrombocytopenia in 8 cases（66.7%）.Grade IV neutropenia occurred in 4 cases（33.3%）,with duration for 1～6 days（median： 3.5 days）.Thrombocytopenia occurred in 3（25%）cases which need platelet transfusion for 1～2 treatment sites.Conclusion PAD regimen should be considered an appropriate treatment for patients failed in VD regimen and patients relapsed after VD regimen and ASCT,which has rapid onset but short duration on patients with extramedullary infiltration.
出处
《实用医院临床杂志》
2011年第4期18-21,共4页
Practical Journal of Clinical Medicine
基金
广东省自然科学基金资助项目(编号:8151008901000064)
