硼替佐米减量BDT方案治疗老年多发性骨髓瘤疗效及安全性分析(1)
【摘要】 目的：探讨硼替佐米(Bortezomib， Btz)减量的BDT方案治疗老年多发性骨髓瘤(multiple myeloma， MM)的疗效及安全性。方法：回顾性分析2007年10月-2013年10月收治的43例以BDT方案治疗的初治老年MM患者的临床资料，评价不同剂量Btz治疗组的疗效及不良反应。结果：2个疗程后，减量组患者的总有效率为72.0%、CR率28.0%，与标准剂量组(总有效率77.8%、CR率33.3%)比较，差异无统计学意义(P>0.05)。Ⅲ级以上不良反应：与标准剂量组相比，减量组的周围神经病变、中性粒细胞减少、感染的发生率明显降低，差异有统计学意义(P<0.05)。结论：Btz减量的BDT方案治疗初治老年MM患者的疗效与标准剂量组相似，但不良反应较标准剂量组明显减少，提示具有更好的耐受性。
【关键词】 多发性骨髓瘤； 硼替佐米； 沙利度胺； 地塞米松； 老年人
【Abstract】 Objective： To discuss the therapeutic effect and safety of the BDT solution quantity of Bortezomib (Btz) for treating multiple myeloma (MM) of the aged. Method： To retrospectively analyze the clinical data of 43 MM patients of the old aged of initial treatment， who accepted from October 2007 to October 2013 and cured with the BDT solution， and evaluate the therapeutic effects and adverse reactions of Btz treatment groups with different dosages. Result： After two courses of treatment， the total effective rate of the patient group with lower quantity was 72.0% and its CR rate was 28.0%， as well as 77.8% of the total effective rate and 33.3% of CR rate of the standard dosage group， there was no statistical significance (P) between the two groups in difference. Adverse reaction higher than Ⅲ level： the generation rates of peripheral neuropathy， neutropenia and infection of the group with lower quantity were obviously decreased compared with those of the standard dosage group， and there was statistical significance in difference (P). Conclusion： The therapeutic effect of the BDT solution with lower quantity of Btz on the MM patient of the aged of initial treatment is similar as that of the standard dosage group， but the adverse reactions of the BDT solution with lower quantity of Btz are obviously reduced， and better tolerance is available.
, http://www.100md.com
【Key words】 Multiple myeloma； Bortezomib； Thalidomide； Dexamethasone； Old patient
First-author’s address： The Fourth People’s Hospital of Shenyang， Shenyang 110031， China
doi：10.3969/j.issn.1674-4985.2015.01.010
多发性骨髓瘤(multiple myeloma， MM)是起源于生发中心后终末分化B淋巴细胞的恶性单克隆性浆细胞疾病，约占血液系统恶性肿瘤的10%，好发于中老年人，且随着年龄增长发病率也在增加[1]。2003年蛋白酶体抑制剂Bortezomib(Btz)被批准用于治疗MM以来，取得了显著疗效，甚至改变了MM的治疗模式。但是因为老年MM患者机体状态差，同时合并多种疾病，使Btz的疗效降低，毒副作用增加，从而限制了Btz在老年患者中的应用。为此，笔者通过观察不同剂量的Btz的BDT方案治疗老年MM患者的疗效及毒副作用，来探讨Btz治疗老年MM患者的最佳使用方法。
1 资料与方法
1.1 一般资料 2007年7月-2013年7月收治的43例初治老年MM患者接受Btz联合沙利度胺及地塞米松(BDT方案)治疗，这些患者均在治疗前评估了合并症、体能等情况，根据评估结果，部分患者调整了Btz的用量，其中25例接受Btz减量治疗，剩余18例均采用标准剂量。所有病例均符合张之南主编的《血液病诊断及疗效标准》[2]，且临床资料完整。43例患者年龄均≥65岁，中位年龄73(65～84)岁，其中男34例，女9例，两组临床资料比较见表1。, 百拇医药(杨朋 蔡存伟 邹志英)
【关键词】 多发性骨髓瘤； 硼替佐米； 沙利度胺； 地塞米松； 老年人
【Abstract】 Objective： To discuss the therapeutic effect and safety of the BDT solution quantity of Bortezomib (Btz) for treating multiple myeloma (MM) of the aged. Method： To retrospectively analyze the clinical data of 43 MM patients of the old aged of initial treatment， who accepted from October 2007 to October 2013 and cured with the BDT solution， and evaluate the therapeutic effects and adverse reactions of Btz treatment groups with different dosages. Result： After two courses of treatment， the total effective rate of the patient group with lower quantity was 72.0% and its CR rate was 28.0%， as well as 77.8% of the total effective rate and 33.3% of CR rate of the standard dosage group， there was no statistical significance (P) between the two groups in difference. Adverse reaction higher than Ⅲ level： the generation rates of peripheral neuropathy， neutropenia and infection of the group with lower quantity were obviously decreased compared with those of the standard dosage group， and there was statistical significance in difference (P). Conclusion： The therapeutic effect of the BDT solution with lower quantity of Btz on the MM patient of the aged of initial treatment is similar as that of the standard dosage group， but the adverse reactions of the BDT solution with lower quantity of Btz are obviously reduced， and better tolerance is available.
, http://www.100md.com
【Key words】 Multiple myeloma； Bortezomib； Thalidomide； Dexamethasone； Old patient
First-author’s address： The Fourth People’s Hospital of Shenyang， Shenyang 110031， China
doi：10.3969/j.issn.1674-4985.2015.01.010
多发性骨髓瘤(multiple myeloma， MM)是起源于生发中心后终末分化B淋巴细胞的恶性单克隆性浆细胞疾病，约占血液系统恶性肿瘤的10%，好发于中老年人，且随着年龄增长发病率也在增加[1]。2003年蛋白酶体抑制剂Bortezomib(Btz)被批准用于治疗MM以来，取得了显著疗效，甚至改变了MM的治疗模式。但是因为老年MM患者机体状态差，同时合并多种疾病，使Btz的疗效降低，毒副作用增加，从而限制了Btz在老年患者中的应用。为此，笔者通过观察不同剂量的Btz的BDT方案治疗老年MM患者的疗效及毒副作用，来探讨Btz治疗老年MM患者的最佳使用方法。
1 资料与方法
1.1 一般资料 2007年7月-2013年7月收治的43例初治老年MM患者接受Btz联合沙利度胺及地塞米松(BDT方案)治疗，这些患者均在治疗前评估了合并症、体能等情况，根据评估结果，部分患者调整了Btz的用量，其中25例接受Btz减量治疗，剩余18例均采用标准剂量。所有病例均符合张之南主编的《血液病诊断及疗效标准》[2]，且临床资料完整。43例患者年龄均≥65岁，中位年龄73(65～84)岁，其中男34例，女9例，两组临床资料比较见表1。, 百拇医药(杨朋 蔡存伟 邹志英)