摘要
目的研究硼替佐米为主的化疗方案治疗多发性骨髓瘤患者的临床疗效及安全性。方法80例患者采用硼替佐米联合地塞米松或硼替佐米联合地塞米松及阿霉素方案化疗。其中16例患者化疗后联合自体或异基因造血干细胞移植巩固治疗。评价其疗效及不良反应，并进行生存分析。结果80例患者中位年龄57（25～78）岁，总反应率80％，完全缓解（CR）率46．3％。中位随访25（1-81）个月，患者1年及2年总生存（OS）率分别为81．4％和72．9％，1年及2年无进展生存（PrS）率分别为76．0％和62．5％。其中16例患者化疗后序贯造血干细胞移植治疗，序贯移植组及单纯化疗组患者2年OS率分别为100．0％和66．0％（P=0．029），2年PFS率分别为73．9％和58．7％（P=0．447）。单因素分析中，影响OS的因素包括Durie—Salmon分期（肾功能是否异常）（P=0．010）、国际分期系统分期（P=0．009）、用药后是否达CR及非常好的部分缓解（VGPR）（P=0．002）、是否序贯造血干细胞移植（P=0．029）；影响PFS的因素包括性别（P=0．026）及是否存在髓外病变（P=0．025）。多因素分析中，延长OS的因素为最佳疗效达CR及VGPR（P=0．001）、Durie—Salmon分期A组（无肾功能异常）（P=0．006）及序贯造血干细胞移植治疗（P=0．052）；延长PFS的因素为男性（P=0．020）及不伴髓外病变（P=0．030）。结论硼替佐米为主的化疗可有效地治疗初治及难治复发的多发性骨髓瘤患者，联合自体或异基因造血干细胞移植可以进一步提高患者0S率。
Objective To evaluate the efficacy and safety of bortezomib-based chemotherapy for 80 patients with multiple myeloma （MM）. Methods A total of 80 cases with a median age of 57 （range： 25-78） years were enrolled in the study. Bortezomib-based regimens included VD （bortezomib and dexamethasone） and PAD （bortezomib, doxombicin and dexamethasone）. 16 of the 80 patients received autologous or allo-hematopoietic stem cell transplantation （HSCT）. Results The overall response （OR） rate was 80%, including a complete response （CR） of 46.3%. After a median follow-up of 25 months, the 1-year and 2-year overall survival （OS） was 81.4% and 72.9%, and the 2-year progression-free survival （PFS） was 76% and 62.5%, respectively. The 2-year OS and PFS were 100% and 73.9 % in patients with HSCT, while both were 66% （P=-0.029） and 58.7% （P=0.447） in patients without HSCT. In univariate analysis, Dnrie-Salmon group, ISS stage, CR and very good partial response （VGPR）, and HSCT were prognostic factors for OS. Gender and extramedullary plasmacytomas were important prognostic factors for PFS. Multivariate analysis by Cox regression revealed that CR and VGPR, Dnrie-Salmon group A, and HSCT were prognostic factors for better OS; while male and patients without extramedullary plasmacytomas were prognostic factors for longer PFS. Conclusion MM patients could benefit from bortezomib-based chemotherapy with satisfactory efficacy and safety. HSCT could improve the OS for young MM patients.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2014年第3期225-230,共6页
Chinese Journal of Hematology
关键词
多发性骨髓瘤
硼替佐米
造血干细胞移植
存活率分析
Multiple myeloma
Bortezomib
Hematopoietic stem cell transplantation
Survival analysis
