Yang Guang-zhong, Chen Wen-ming
Department of Hematology, Multiple Myeloma Research Center of Beijing, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2010 Oct 19;90(38):2671-4.
To analyze the outcomes and adverse effects of bortezomib-based regimen for the treatment of multiple myeloma (MM) patients.
A total of 110 MM patients were treated with a bortezomib-based regimen at our hospital from January 2006 to February 2010. The patients over 65 years old received bortezomib-prednisone ± thalidomide (PD±T) regimen or velcade-melphalan-prednisone (VMP) regimen therapy and the patients under 65 years old or resistant to PD±T regimen received bortezomib-doxorubicin-prednisone ± thalidomide (PAD±T) regimen therapy. The outcomes and adverse effects of bortezomib-based regimen were retrospectively evaluated.
There were 47 newly-diagnosed MM patients and 63 relapsing/refractory MM patients. The overall remission (OR) rate was 76.4% (84/110) and the OR rate of newly-diagnosed MM patients was statistically higher than that of relapsing/refractory MM patients (83.0% vs 71.4%, P<0.05). The complete remission (CR)+very good partial remission (VGPR) rate in group bortezomib 1.0 mg/m2 was lower than that in group bortezomib 1.3 mg/m2 (newly-diagnosed 53.6% vs 73.7%, relapsing/refractory 28.9% vs 40.0%, both P<0.05). The OR rate of ISS III stage patients was as better as that of ISS I and II stage patients (newly-diagnosed 82.1% vs 83.6%, relapsing/refractory 69.2% vs 72.2%, both P>0.05). Thirteen newly-diagnosed MM patients underwent autologous stem cell transplantation (ASCT) after induced therapy and achieved a VGPR or above. The median follow-up time was 13.0 (6.0-20.0) months. Their conditions were stable except two patients with extramedullary plasmacytoma after ASCT. Thirteen relapsing/refractory MM patients were retreated with a bortezomib-based regimen. The CR rate was 15.4% (2/13), VGPR rate was 23.1% (3/13), partial remission (PR) rate was 23.1% (3/13), OR rate 61.5% (8/13) and the median duration of remission (DOR) was 6.7 (3.0-21.0) months. Six MM patients with extramedullary plasmacytoma were treated with a bortezomib-based regimen and all of them achieved a PR or above. The median DOR was 4.5 (2.0-10.0) months. The main adverse effects were peripheral neuropathy, thrombocytopenia, neutropenia, fatigue, gastrointestinal symptoms, anemia, etc.
The bortezomib-based combination regimen is the front-line therapy for newly-diagnosed and relapsing/refractory MM patients.
分析以硼替佐米为基础的方案治疗多发性骨髓瘤（MM）患者的疗效及不良反应。
2006年1月至2010年2月，我院共110例MM患者接受了以硼替佐米为基础的方案治疗。65岁以上患者接受硼替佐米-泼尼松±沙利度胺（PD±T）方案或万珂-美法仑-泼尼松（VMP）方案治疗，65岁以下或对PD±T方案耐药的患者接受硼替佐米-阿霉素-泼尼松±沙利度胺（PAD±T）方案治疗。对以硼替佐米为基础的方案的疗效及不良反应进行回顾性评估。
新诊断MM患者47例，复发/难治性MM患者63例。总缓解（OR）率为76.4%（84/110），新诊断MM患者的OR率在统计学上高于复发/难治性MM患者（83.0%对71.4%，P<0.05）。硼替佐米1.0mg/m2组的完全缓解（CR）+非常好的部分缓解（VGPR）率低于硼替佐米1.3mg/m2组（新诊断患者分别为53.6%对73.7%，复发/难治性患者分别为28.9%对40.0%，P均<0.05）。国际分期系统（ISS）III期患者的OR率与ISS I期和II期患者相当（新诊断患者分别为82.1%对83.6%，复发/难治性患者分别为69.2%对72.2%，P均>0.05）。13例新诊断MM患者诱导治疗后接受自体干细胞移植（ASCT），并达到VGPR或更高缓解。中位随访时间为13.0（6.0 - 20.0）个月。除2例ASCT后发生髓外浆细胞瘤的患者外，其余患者病情稳定。13例复发/难治性MM患者接受以硼替佐米为基础的方案再次治疗。CR率为15.4%（2/13），VGPR率为23.1%（3/13），部分缓解（PR）率为23.1%（3/13），OR率为61.5%（8/13），中位缓解持续时间（DOR）为6.7（3.0 - 21.0）个月。6例髓外浆细胞瘤MM患者接受以硼替佐米为基础的方案治疗，均达到PR或更高缓解。中位DOR为4.5（2.0 - 10.0）个月。主要不良反应为周围神经病变、血小板减少、中性粒细胞减少、疲劳、胃肠道症状、贫血等。
以硼替佐米为基础的联合方案是新诊断和复发/难治性MM患者的一线治疗方案。
