本文關(guān)鍵詞：個體化硼替佐米治療對多發(fā)性骨髓瘤的療效　出處：《皖南醫(yī)學院》2015年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 硼替佐米 多發(fā)性骨髓瘤 個體化

【摘要】：目的:通過回顧性分析皖南醫(yī)學院弋磯山醫(yī)院血液內(nèi)科60例多發(fā)性骨髓瘤患者分別行個體化硼替佐米治療方案和傳統(tǒng)的治療方案,對兩組方案的總緩解率,總生存率及各種不良反應(yīng)進行分析對比,探討個體化以硼替佐米為基礎(chǔ)的治療方案在骨髓瘤患者中的應(yīng)用,為今后該類患者的臨床治療提供參考。方法:選取2010.1至2014.7于本皖南醫(yī)學院弋磯山醫(yī)院血液內(nèi)科住院的60例患者作為研究對象,分為2組進行回顧性分析。第一組:20例多發(fā)性骨髓瘤患者均接受BDT(硼替佐米,地塞米松,沙利度胺)治療,其中有7例接受1.75mg(0.8-1.0mg/m2)硼替佐米,第1,8天,另13例接受1.3mg/m2,第1,4,8,11天;地塞米松5-15mg/d,第1-4,8-11天;沙利度胺持續(xù)治療,劑量100-150mg;此方案21天一療程,療程結(jié)束后仍沙利度胺維持治療,在治療過程中若有不適則調(diào)整劑量或是延遲治療。第二組:另有40例患者接受傳統(tǒng)的化療方案,其中包括11例接受MPT(馬法蘭4mg/m2/d,潑尼松40mg/m2/d,均口服7天;沙利度胺每晚連續(xù)服用100mg),29例接受VADT(長春新堿0.7mg,第1-4天,阿霉素10mg,第1-4天,地塞米松40mg,第1-4,9-12,17-20天,并且每晚使用沙利度胺100-200mg)方案,兩者均28天后重復(fù)給藥,期間沙利度胺維持治療。均完成4個療程。結(jié)果:個體化BDT治療組中,其完全緩解(CR)是10%,很好的部分緩解(VGPR)是50%,部分緩解(PR)是20%,病情穩(wěn)定(SD)是5%,進展是15%;傳統(tǒng)方案治療組的CR為2.5%,VGPR為37.5%,PR為17.5%,SD為30%,進展為12.5%,兩組的ORR分別為80%,57.5%(P0.05),差距有統(tǒng)計學意義;個體化BDT組的2年和3年OS均較傳統(tǒng)治療組高(P0.05);在治療后的不良反應(yīng)中,兩組的白細胞、血小板減少和周圍神經(jīng)病變、感染等并發(fā)癥未見差異,個體化BDT組帶狀皰疹的發(fā)生率偏高,而傳統(tǒng)治療組的乏力和心臟毒性發(fā)生率偏高;對于腎功能不全患者與腎功能正�；颊叩闹委熡行蕿�75%vs 83.3%(P0.05),且個體化BDT組的腎功能均見好轉(zhuǎn)。結(jié)論:個體化BDT方案治療MM是一種相對有效且安全的方案。
[Abstract]:Objective: to analyze the total remission rate of 60 patients with multiple myeloma treated with individualized bortezomib and traditional therapy respectively through retrospective analysis of 60 patients with multiple myeloma in the Department of Hematology of Yiji Mountain Hospital of Southern Anhui Medical College. The overall survival rate and various adverse reactions were analyzed and compared to explore the application of individualized bortezomib therapy in myeloma patients. Methods: from 2010.1 to 2014.7, 60 patients hospitalized in the Department of Hematology of Gi Jishan Hospital of Southern Anhui Medical College were selected as the study objects. The first group of 20 patients with multiple myeloma were treated with BDT( bortezomil, dexamethasone, thalidomide). Seven of them received 1.75 mg / m ~ (2) -1.0 mg / m ~ (2) borotezomil on the 8th day, and 13 cases received 1.3 mg / m ~ (2) on the 11th day. Dexamethasone 5-15 mg / d, 1-4 days 8-11; Thalidomide continuous therapy, dose 100-150 mg; The course of treatment was 21 days. Thalidomide was maintained at the end of the course. If there was any discomfort in the course of treatment, the dosage was adjusted or delayed. Group 2: another 40 patients received traditional chemotherapy regimen. These included 11 patients who received MPT (4 mg / m2 / d, 40 mg / m2 / d prednisone) for 7 days; Twenty-nine patients with thalidomide were treated with VADT (vincristine 0.7 mg, day 1-4, adriamycin 10 mg, day 1-4, dexamethasone 40 mg) every night. Regimen 1-4, 9-12, 17-20 days, and every night, thalidomide 100-200 mg), both were repeated after 28 days. During thalidomide maintenance therapy, 4 courses of treatment were completed. Results: in the individualized BDT group, the complete remission rate was 10, and the good partial remission was 50%. PRA of partial remission is 20, SD5 of disease is stable, progress is 15; In the traditional treatment group, the CR was 2.5 and the VGPR was 37.5 and the PR was 17.5and the SD was 30 and the progression was 12.5.The ORR of the two groups was 80%. 57.5% P0.05, the difference is statistically significant; The OS of 2 and 3 years in the individualized BDT group was higher than that in the traditional treatment group (P 0.05). In the treatment of adverse reactions, the two groups of leukopenia, peripheral neuropathy, infection and other complications, the incidence of herpes zoster in the individualized BDT group was higher. The incidence of fatigue and cardiac toxicity in the traditional treatment group was higher than that in the control group. The effective rate of treatment for patients with renal insufficiency and normal renal function was 75 vs 83.3% (P0.05). The renal function of individual BDT group was improved. Conclusion: individualized BDT regimen is a relatively effective and safe regimen for the treatment of MM.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R733.3

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