个体化硼替佐米治疗对多发性骨髓瘤的疗效

发布时间：2018-01-08 00:34

本文关键词：个体化硼替佐米治疗对多发性骨髓瘤的疗效　出处：《皖南医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过回顾性分析皖南医学院弋矶山医院血液内科60例多发性骨髓瘤患者分别行个体化硼替佐米治疗方案和传统的治疗方案,对两组方案的总缓解率,总生存率及各种不良反应进行分析对比,探讨个体化以硼替佐米为基础的治疗方案在骨髓瘤患者中的应用,为今后该类患者的临床治疗提供参考。方法:选取2010.1至2014.7于本皖南医学院弋矶山医院血液内科住院的60例患者作为研究对象,分为2组进行回顾性分析。第一组:20例多发性骨髓瘤患者均接受BDT(硼替佐米,地塞米松,沙利度胺)治疗,其中有7例接受1.75mg(0.8-1.0mg/m2)硼替佐米,第1,8天,另13例接受1.3mg/m2,第1,4,8,11天;地塞米松5-15mg/d,第1-4,8-11天;沙利度胺持续治疗,剂量100-150mg;此方案21天一疗程,疗程结束后仍沙利度胺维持治疗,在治疗过程中若有不适则调整剂量或是延迟治疗。第二组:另有40例患者接受传统的化疗方案,其中包括11例接受MPT(马法兰4mg/m2/d,泼尼松40mg/m2/d,均口服7天;沙利度胺每晚连续服用100mg),29例接受VADT(长春新碱0.7mg,第1-4天,阿霉素10mg,第1-4天,地塞米松40mg,第1-4,9-12,17-20天,并且每晚使用沙利度胺100-200mg)方案,两者均28天后重复给药,期间沙利度胺维持治疗。均完成4个疗程。结果:个体化BDT治疗组中,其完全缓解(CR)是10%,很好的部分缓解(VGPR)是50%,部分缓解(PR)是20%,病情稳定(SD)是5%,进展是15%;传统方案治疗组的CR为2.5%,VGPR为37.5%,PR为17.5%,SD为30%,进展为12.5%,两组的ORR分别为80%,57.5%(P0.05),差距有统计学意义;个体化BDT组的2年和3年OS均较传统治疗组高(P0.05);在治疗后的不良反应中,两组的白细胞、血小板减少和周围神经病变、感染等并发症未见差异,个体化BDT组带状疱疹的发生率偏高,而传统治疗组的乏力和心脏毒性发生率偏高;对于肾功能不全患者与肾功能正常患者的治疗有效率为75%vs 83.3%(P0.05),且个体化BDT组的肾功能均见好转。结论:个体化BDT方案治疗MM是一种相对有效且安全的方案。
[Abstract]:Objective: to analyze the total remission rate of 60 patients with multiple myeloma treated with individualized bortezomib and traditional therapy respectively through retrospective analysis of 60 patients with multiple myeloma in the Department of Hematology of Yiji Mountain Hospital of Southern Anhui Medical College. The overall survival rate and various adverse reactions were analyzed and compared to explore the application of individualized bortezomib therapy in myeloma patients. Methods: from 2010.1 to 2014.7, 60 patients hospitalized in the Department of Hematology of Gi Jishan Hospital of Southern Anhui Medical College were selected as the study objects. The first group of 20 patients with multiple myeloma were treated with BDT( bortezomil, dexamethasone, thalidomide). Seven of them received 1.75 mg / m ~ (2) -1.0 mg / m ~ (2) borotezomil on the 8th day, and 13 cases received 1.3 mg / m ~ (2) on the 11th day. Dexamethasone 5-15 mg / d, 1-4 days 8-11; Thalidomide continuous therapy, dose 100-150 mg; The course of treatment was 21 days. Thalidomide was maintained at the end of the course. If there was any discomfort in the course of treatment, the dosage was adjusted or delayed. Group 2: another 40 patients received traditional chemotherapy regimen. These included 11 patients who received MPT (4 mg / m2 / d, 40 mg / m2 / d prednisone) for 7 days; Twenty-nine patients with thalidomide were treated with VADT (vincristine 0.7 mg, day 1-4, adriamycin 10 mg, day 1-4, dexamethasone 40 mg) every night. Regimen 1-4, 9-12, 17-20 days, and every night, thalidomide 100-200 mg), both were repeated after 28 days. During thalidomide maintenance therapy, 4 courses of treatment were completed. Results: in the individualized BDT group, the complete remission rate was 10, and the good partial remission was 50%. PRA of partial remission is 20, SD5 of disease is stable, progress is 15; In the traditional treatment group, the CR was 2.5 and the VGPR was 37.5 and the PR was 17.5and the SD was 30 and the progression was 12.5.The ORR of the two groups was 80%. 57.5% P0.05, the difference is statistically significant; The OS of 2 and 3 years in the individualized BDT group was higher than that in the traditional treatment group (P 0.05). In the treatment of adverse reactions, the two groups of leukopenia, peripheral neuropathy, infection and other complications, the incidence of herpes zoster in the individualized BDT group was higher. The incidence of fatigue and cardiac toxicity in the traditional treatment group was higher than that in the control group. The effective rate of treatment for patients with renal insufficiency and normal renal function was 75 vs 83.3% (P0.05). The renal function of individual BDT group was improved. Conclusion: individualized BDT regimen is a relatively effective and safe regimen for the treatment of MM.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R733.3

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