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目的观察硼替佐米联合地塞米松治疗多发性骨髓瘤患者的疗效、与疗效有关的预后因素及化疗毒副反应。方法2006年5月至2008年7月中山大学附属第一医院40例初治、难治和(或)复发MM患者接受硼替佐米联合地塞米松(VD)方案治疗,每3周为1个疗程。结果总反应率75.0%(30/40),完全缓解(CR)+接近完全缓解(nCR)率42.5%(17/40),80.0%(24/30)患者在1个疗程后即可看到疗效,中位达最佳疗效时间为2个疗程。与非轻链患者相比,轻链型患者总反应率(100.0%对65.5%,P=0.038)和CR率(36.4%对6.9%,P=0.039)均明显高于前者,而且起效更快,81.8%(9/11)的患者在1个疗程后即达最佳疗效。VD方案Ⅲ～Ⅳ级不良反应发生率低,包括白细胞减少、血小板减少、腹泻和乏力,经对症治疗或推迟化疗后均可恢复。感染发生率高(35.0%),是重要的死亡原因之一。结论硼替佐米联合地塞米松治疗MM患者有明显疗效,在轻链型患者疗效更加显著,起效更快,副反应可以耐受。
Objective To observe the curative effect of bortezomib combined with dexamethasone in patients with multiple myeloma, prognostic factors related to curative effect, and chemotherapy toxicity. Methods From May 2006 to July 2008, 40 patients with newly diagnosed, refractory or recurrent MM in the First Affiliated Hospital of Sun Yat-sen University underwent bortezomib plus dexamethasone (VD) regimen every three weeks Course of treatment. Results The overall response rate was 75.0% (30/40), complete remission (CR) + near complete remission (nCR) rate was 42.5% (17/40), and 80.0% (24/30) patients were seen after 1 course of treatment Efficacy, the best time to reach the two courses of treatment. The overall response rate (100.0% vs 65.5%, P = 0.038) and CR rate (36.4% vs 6.9%, P = 0.039) in patients with mild to light chain were significantly higher than those in non-light-weight patients Fast, 81.8% (9/11) of the patients in a course of treatment to achieve the best effect. VD program Ⅲ ~ Ⅳ adverse reactions occur low, including leukopenia, thrombocytopenia, diarrhea and fatigue, can be restored after symptomatic treatment or postponed chemotherapy. The high incidence of infection (35.0%) is one of the important causes of death. Conclusion Bortezomib combined with dexamethasone in patients with MM has a significant effect, the efficacy of more effective in patients with light chain, faster onset of side effects can be tolerated.