Am J Hematol. 2010 Oct;85(10):812-5. doi: 10.1002/ajh.21823.
Treatment-related mortality (TRM) is not uncommon in patients after the first course of vincristine-doxorubicin-dexamethasone (VAD) chemotherapy,but quite rare after melphalan-prednisolone (MP). This motivated us to compare the rates of TRM after the first course of VAD with those after the first course of MP. We retrospectively assessed survival and TRM in 179 patients treated for multiple myeloma with either MP or VAD. Survival was similar in two groups (P 50.463 in log-rank test). However, TRM was significantly higher inpatients after the first course of VAD (11 in 100 patients, 11.0%) than that after the first course of MP (1 in 79, 1.3%; P 5 0.010). Poor performance status (P 5 0.004) and advanced age (P 5 0.009) before treatment were independent significant factors associated with TRM after the first course of induction therapy. Pyogenic infection was the major cause of TRM after VAD (9 in 11, 81.8%). We concluded that VAD should be cautiously used as induction therapy in multiple myeloma patients, especially in elderly and/or those with poor performance status.
在接受长春新碱-多柔比星-地塞米松（VAD）化疗的第一疗程后，患者发生治疗相关死亡率（TRM）并不罕见，但在接受马法兰-泼尼松（MP）治疗后，TRM 相当罕见。这促使我们比较 VAD 第一疗程与 MP 第一疗程后 TRM 的发生率。我们回顾性评估了 179 例接受 MP 或 VAD 治疗的多发性骨髓瘤患者的生存和 TRM。两组患者的生存情况相似（对数秩检验 P 5 0.463）。然而，VAD 第一疗程后患者的 TRM 明显更高（100 例中有 11 例，11.0%），而 MP 第一疗程后患者的 TRM 为 1 例（79 例，1.3%；P 5 0.010）。治疗前较差的体能状态（P 5 0.004）和高龄（P 5 0.009）是与诱导治疗第一疗程后 TRM 相关的独立显著因素。化脓性感染是 VAD 后 TRM 的主要原因（11 例中有 9 例，81.8%）。我们得出结论，VAD 应谨慎用于多发性骨髓瘤患者的诱导治疗，尤其是在老年患者和/或体能状态较差的患者中。
