沙利度胺治疗26例多发性骨髓瘤患者的临床研究
【摘要】 目的 探讨沙利度胺(thalidomide,Thal)治疗多发性骨髓瘤(MM)患者的疗效及安全性。方法 回顾性分析Thal单药及联合其他化疗方案治疗26例MM患者的疗效及不良反应。结果 ① 26例患者共接受Thal治疗36例次，中位用药剂量200mg/d。② 13例次患者诱导治疗的有效率为69.2%,17例次患者挽救治疗有效率为47.1%。其中Thal单药治疗3例次，联合化疗25例次；联合组的有效率优于单药组(分别为60.0%和33.3%，P=0.015)，无反应和疾病进展(NR)率低于单药组(分别为12.0%和66.7%，P=0.013)。③ 采用Thal维持治疗的患者用药至疾病进展的中位时间为14.7(1～52)个月。④ 在可随访的24例患者中，患者使用Thal 的中位用药时间为9(1～51)个月。中位随访19(1～58)个月，预计中位总体生存(OS)期42个月。单因素分析显示累计用药时间长于6个月(P=0.0014)，治疗前骨髓涂片巨核细胞多于20个/片(P=0.0101)，血红蛋白浓度大于100g/L(P=0.019)的患者OS期较长。⑤ 多因素分析显示累计用药时间长于6个月[P=0.006，相对危险度(RR)0.430]，骨髓涂片巨核细胞多于20个/片(P=0.036,RR0.502)是OS期的预后良好因素。⑥ 患者对Thal治疗的不良反应多可耐受。结论 Thal单药或联合化疗对MM患者有疗效。累计用药时间达6个月者可以显著提高OS时间。
, http://www.100md.com
【关键词】多发性骨髓瘤 沙利度胺 治疗结果 不良反应
中图分类号：R733.3 文献标识码：A 文章编号：1005-0515(2011)5-027-02
The efficacy of thalidomide for multiple myeloma:a clinical analysis of 26 Chinese patients
YUAN Ying Dong Gui-jun Zheng Li
(The center hospital of Guang Yuan,Sichuan628000,China)
【Abstract】Objective To analyse the efficacy and safety of thalidomide ( Thal ) for patients with multiple myeloma ( MM ) . Methods Effectiveness and adverse events of 26 MM patients treated with thalidomide at a median dosage of 200mg/d. Three cases were treated with Thal alone ( group A ) , and 25 case with Thal in comhination with other therapeutic agents ( group B )wereretrospectively analyzed . Result ① The response rate (RR) ( was 69.2% for induction therapy in 13 cases and 47.1% for salvage therapy in 17 cases . RR in group B was higher than that in group A(60.0%versus33.3/%,P=0.015),andthenon-response/progress(NR)rate was Iower (12.0% versus 66.7%,P=0.013 ).② The median duration of response maintenance was 14.7 (1.0～52.0) months in 6 cases .③Among 24 patients with follow-up data,the estimated median duration of 0S was 42 months in a median follow-up durationof19 months and the accumulative time for use of Thal was9 months. In univariate analysis,the accumulative duration for use of Thal≥6monlhs,hemoglobin≥100g/L and bone marrow megakaryocytes>20 per smear were associated with longer OS(P=0.0014,0.0101,0.019,respectively).④ Multivariate analysis suggested that the accumulative time for use of Thal and bone marrow megakaryocytes > 20 were independent good prognostic factors for 0S(P=0.006,0.036,respectively).⑤ The adverse events of Thal were mostly endurable. Conclusion Thalidomide alone or combined with chemotherapy is an useful therapy for MM . The accumulative time for use longer than 6 months may improve survival .
, 百拇医药
【Key words】Multiple myelomaThalidomide Response Adverse events
多发性骨髓瘤(multiple myeloma ,MM)是老年人常见的血液系统恶性肿瘤，至今尚不能完全治愈。沙利度胺(thalidomine , Thal)通过抑制血管新生、减少白细胞介素6(IL-6)的产生等机制具有抗骨髓瘤作用，近年来广泛应用于MM 的治疗[1]。现将我院26例采用Thal 治疗的MM 患者的临床资料进行了总结，分析了Thal 单药及联合其他化疗方案治疗MM 患者的近、远期疗效及不良反应，以期为MM 治疗方案的选择提供参考。
1 病例和方法
1.1 病例资料 病例为我院2001年8月1日至2008年6月30 日住院或门诊具有完整治疗和随访资料的MM患者。诊断依据为张之南等[2]主编的《血液病诊断及疗效标准》。
1.2 治疗分组 ① Thal组：Thal单药应用。② Thal联合地塞米松/泼尼松或干扰素(IFN)或MP[苯丙氨酸氮芥(马法兰)和泼尼松]地塞米松[(30-40)mg/d口服，第l～4d、9～12d、17～20d或泼尼松(40mg/d×7d)；IFN 300万U皮下注射，隔天1次；MP方案：苯丙氨酸氮芥8mg/d,泼尼松60mg/d，第1～7d。每1个月为1个疗程。③长春新碱0.4mg/d，多柔比星9mg.m-2.d-1持续静脉点滴4d，地塞米松30～40mg/d 口服，第1～4d、9～12，17～20d。每l个月为l个疗程。, http://www.100md.com(袁颖 董桂君 郑立)
, http://www.100md.com
【关键词】多发性骨髓瘤 沙利度胺 治疗结果 不良反应
中图分类号：R733.3 文献标识码：A 文章编号：1005-0515(2011)5-027-02
The efficacy of thalidomide for multiple myeloma:a clinical analysis of 26 Chinese patients
YUAN Ying Dong Gui-jun Zheng Li
(The center hospital of Guang Yuan,Sichuan628000,China)
【Abstract】Objective To analyse the efficacy and safety of thalidomide ( Thal ) for patients with multiple myeloma ( MM ) . Methods Effectiveness and adverse events of 26 MM patients treated with thalidomide at a median dosage of 200mg/d. Three cases were treated with Thal alone ( group A ) , and 25 case with Thal in comhination with other therapeutic agents ( group B )wereretrospectively analyzed . Result ① The response rate (RR) ( was 69.2% for induction therapy in 13 cases and 47.1% for salvage therapy in 17 cases . RR in group B was higher than that in group A(60.0%versus33.3/%,P=0.015),andthenon-response/progress(NR)rate was Iower (12.0% versus 66.7%,P=0.013 ).② The median duration of response maintenance was 14.7 (1.0～52.0) months in 6 cases .③Among 24 patients with follow-up data,the estimated median duration of 0S was 42 months in a median follow-up durationof19 months and the accumulative time for use of Thal was9 months. In univariate analysis,the accumulative duration for use of Thal≥6monlhs,hemoglobin≥100g/L and bone marrow megakaryocytes>20 per smear were associated with longer OS(P=0.0014,0.0101,0.019,respectively).④ Multivariate analysis suggested that the accumulative time for use of Thal and bone marrow megakaryocytes > 20 were independent good prognostic factors for 0S(P=0.006,0.036,respectively).⑤ The adverse events of Thal were mostly endurable. Conclusion Thalidomide alone or combined with chemotherapy is an useful therapy for MM . The accumulative time for use longer than 6 months may improve survival .
, 百拇医药
【Key words】Multiple myelomaThalidomide Response Adverse events
多发性骨髓瘤(multiple myeloma ,MM)是老年人常见的血液系统恶性肿瘤，至今尚不能完全治愈。沙利度胺(thalidomine , Thal)通过抑制血管新生、减少白细胞介素6(IL-6)的产生等机制具有抗骨髓瘤作用，近年来广泛应用于MM 的治疗[1]。现将我院26例采用Thal 治疗的MM 患者的临床资料进行了总结，分析了Thal 单药及联合其他化疗方案治疗MM 患者的近、远期疗效及不良反应，以期为MM 治疗方案的选择提供参考。
1 病例和方法
1.1 病例资料 病例为我院2001年8月1日至2008年6月30 日住院或门诊具有完整治疗和随访资料的MM患者。诊断依据为张之南等[2]主编的《血液病诊断及疗效标准》。
1.2 治疗分组 ① Thal组：Thal单药应用。② Thal联合地塞米松/泼尼松或干扰素(IFN)或MP[苯丙氨酸氮芥(马法兰)和泼尼松]地塞米松[(30-40)mg/d口服，第l～4d、9～12d、17～20d或泼尼松(40mg/d×7d)；IFN 300万U皮下注射，隔天1次；MP方案：苯丙氨酸氮芥8mg/d,泼尼松60mg/d，第1～7d。每1个月为1个疗程。③长春新碱0.4mg/d，多柔比星9mg.m-2.d-1持续静脉点滴4d，地塞米松30～40mg/d 口服，第1～4d、9～12，17～20d。每l个月为l个疗程。, http://www.100md.com(袁颖 董桂君 郑立)