CET方案治疗老年难治复发性多发性骨髓瘤临床探究.docVIP

CET方案治疗老年难治复发性多发性骨髓瘤临床探究 　【摘要】 目的 探讨环磷酰胺联合足叶乙苷化疗（CE）并序贯口服沙利度胺（Thal）治疗老年难治复发性多发性骨髓瘤的临床疗效及相关毒副作用。 方法 给予13例老年难治复发性MM患者CE方案化疗：环磷酰胺（CTX）300 mg/m2，d1～3；足叶乙苷(VP16) 75mg/m2，d1～3。每四周重复，化疗间歇期序贯口服沙利度胺50～75 mg，2次/d。4～6疗程后根据患者M蛋白、骨髓浆细胞数、血常规、免疫球蛋白、生化等评价疗效及毒副反应。结果 CR 1例（7.69%），PR 7例（53.85%），SD 3例（23.08%），PD 2例（15.38%），总缓解率61.54%，且毒副作用较轻。结论 CE方案化疗序贯口服沙利度胺疗效确切，毒副反应轻，是治疗难治复发性MM的较为合适的方案，值得临床推广。 【关键词】 多发性骨髓瘤；沙利度胺；联合化疗 　　Abstract： Objective To research the clinical curative effect and side effects on the combination of cyclophosphomide (CTX) and etoposide(Vp-16), and taking thalidomide(Thal) orally in sequential to treat refractory and recurrent multiple myeloma(MM) of the aged people.Methods 13 cases of refractory and recurrent multiple myeloma in old aged were treated with the CE measures: CTX 300 mg/m2，D1-3; Vp16 75 mg/m2，D1-3，every four weeks. The patients took Thal orally in the intermittence of chemotherapy , twice one day. After 4-6 periods of treatment, we evaluate the clinical curative effect and side effects based on the M protein，the ammount of plasma cells in bone marrow，blood routine, immunoglobin and blood biochemistrical test etc. Results One patient achieved complete remission(CR),the CR rate was 7.09％.Seven patients achieved partial remission(PR), the PR rate was 53.85％.Three patients was stable, the SD was 23.08％.The disease of two patients was progressive, The PD rate was 15.38％.The overall remission rate was 61.54％.And meanwhile, the side effects was tolerable. Conclusion The CET regimen is a appropriate measure to treat the refractory and recurrent MM in aged people. 　　Key words： multiple myeloma; thalidomide; combinative chemotherapy 　　多发性骨髓瘤（MM）是一种浆细胞克隆性增生的临床常见的血液恶性肿瘤，以骨质破坏、肾功能损害、贫血及高钙血症等为主要临床特征，其发病率占恶性肿瘤的1%，占血液系统恶性肿瘤的10%，随着社会的老龄化，近年来，MM的发病率有逐年增高的趋势。MM是目前仍不能治愈的恶性血液肿瘤，目前治疗仍以联合化疗为主，但是完全缓解率低，5年生存率低于10%。近年来，随着一些靶向药物的应用，如抗血管生成药物沙利度胺（Thalidomide，Thal，反应停）、蛋白酶体抑制剂硼替佐咪（万珂，Vacad）等，MM的治疗取得较大进展。我们采用CE方案联合化疗并序贯口服沙利度胺治疗难治复发性MM13例，取得较好疗效，现报告如下。 　　1 材料与方法 　　1.1 研究对象 为2003年7