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改良PAD方案治疗初发多发性骨髓瘤的疗效及安全性

Efficacy and safety of modified PAD regimen in the treatment of primary multiple myeloma

  • 摘要: 目的:探讨不同硼替佐米剂量的PAD方案(硼替佐米+表阿霉素+地塞米松)治疗多发性骨髓瘤(multiple myeloma,MM)的疗效和安全性。方法:回顾性分析PAD方案治疗的32例MM患者的临床资料。其中,硼替佐米1.3 mg/m2 静脉注射(d 1、d 4、d 8、d 11)+表阿霉素20 mg静脉滴注(d 1~4)+地塞米松20 mg静脉滴注(d 1~4、d 8~11)治疗20例(PAD 1组);硼替佐米1.6 mg/m2 静脉注射(d 1、d 8、d 15) +表阿霉素20 mg静脉滴注(d 1、d 8、d 15)+地塞米松20 mg静脉滴注(d 1~2、d 8~9、d 15~16)治疗12例(PAD 2组)。两组均以28 d为1个疗程,化疗3~6疗程。比较两组MM患者完成3个疗程后的疗效与不良反应。结果:PAD 1组总有效率为80.0%,PAD 2组为83.3%,两组差异无统计学意义。PAD 1组带状疱疹(30.0% vs 0%)患者多于PAD 2组,差异有统计学意义(P<0.05);PAD 1组与PAD 2组胃肠道反应(20.0% vs 16.7%)、周围神经炎(25.0% vs 16.7%)、粒细胞减少(15.0% vs 16.0%)、血小板减少(10.0% vs 8.0%)患者差异无统计学意义。结论:硼替佐米1.6 mg/m2 每周1次静脉注射的PAD方案治疗与硼替佐米1.3 mg/m2 每周2次静脉注射的PAD方案疗效相似,且硼替佐米1.6 mg/m2 每周1次静脉注射的PAD方案不良反应更少,更为安全。

     

    Abstract: Objective:To observe the efficacy and safety of two PAD regimens with different doses of bortezomib (bortezomib + Epirubicin + dexamethasone) in the treatment of patients with multiple myeloma (MM). Methods:The clinical data of 32 MM patients treated with PAD regimens were retrospectively analyzed. The doses of intravenous bortezomib were different in two PAD regimens. Patients in group PAD 1 (n=20) received bortezomib 1.3 mg/m2 through intravenous injection on d 1, d 4, d 8, and d 11, epirubicin 20 mg through intravenous infusion on d 1 to d 4, and dexamethasone 20 mg through intravenous infusion d 1 to d 4, and d 8 to d 11. Patients in group PAD 2 (n=12) received bortezomib 1.6 mg/m2 through intravenous injection on d 1, d 8, and d 15, epirubicin 20 mg through intravenous infusion on d 1, d 8, and d 15, and dexamethasone 20 mg through intravenous infusion on d 12, d 89, and d 1516. All patients received 3 to 6 courses of treatment and each course lasted for 28 days. Clinical efficacy and adverse reactions of two groups of MM patients were compared after the completion of 3 courses. Results:After the first three courses, the effective rate of group PAD 1 was 80.0%, the effective rate of group PAD 2 was 83.3%, and there was no significant difference between the two groups. There were more herpes zoster patients in group PAD 1 than group PAD 2 (30% vs 0%), and the difference was statistically significant (P<0.05). There were no statistical differences in the incidence of gastrointestinal reaction, peripheral neuritis, granulocytopenia, and thrombocytopenia between the two groups (20.0% vs 16.7%, 25.0% vs 16.7%, 15.0% vs 16.0%, and 10.0% vs 8.0%, P>0.05). Conclusions:The PAD regimen with intravenous injection of bortezomib 1.6 mg/m2 once a week is similar to the PAD regimen with intravenous injection of bortezomib 1.3 mg/m2 twice a week in efficacy, but it is safer with less adverse reactions.

     

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