本文選題：來那度胺 + 初診多發(fā)性骨髓瘤　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:系統(tǒng)評價公開發(fā)表的含來那度胺的聯(lián)合化療治療初診多發(fā)性骨髓瘤的療效與安全性。方法:通過中國知網(wǎng)(CNKI)、中國生物醫(yī)學(xué)文摘(CBM)、萬方數(shù)據(jù)知識服務(wù)平臺(Wanfang)、維普網(wǎng)(VIP)、Medline、Pub Med、Clinical Trials.gov等中英文數(shù)據(jù)庫,檢索限定的時限都從2005年截止至2017年1月,檢索關(guān)鍵詞:初診多發(fā)性骨髓瘤或初治多發(fā)性骨髓瘤(the newly diagnosed multiple myeloma or the untreated multiple myeloma)、免疫調(diào)節(jié)劑(Immune modulators)、來那度胺(lenalidomide)等,檢索已發(fā)表的關(guān)于來那度胺聯(lián)合化療方案治療初治MM患者的臨床試驗文獻,提取試驗中緩解率、PFS、OS和藥物的不良反應(yīng)等數(shù)據(jù)。合并效應(yīng)量后使用Rev Man5.3軟件評價分析。結(jié)果:共納入6篇文獻,合計參與者1621人,來那度胺組848人,對照組773人,其中有4篇來那度胺與安慰劑的比較,2篇來那度胺與沙利度胺的比較。1、來那度胺組的CR/VGPR率、OR率高于對照組[OR=3.66,95%CI(2.87,4.66),P0.00001,P0.05;OR=2.47,95%CI(1.99,3.05),P0.00001,P0.05]。2、來那度胺治療的初診MM的1年和20個月PFS長于對照組[OR=2.25,95%CI(1.81,2.79),P0.00001,P0.05;OR=1.74,95%CI(1.40,1.2.16),P0.00001,P0.05]。3、來那度胺組在與對照組1年和20個月OS的比較中,結(jié)果相似[OR=1.28,95%CI(0.90,1.80),P=0.17,P0.05;OR=0.98,95%CI(0.75,1.28),P=0.90,P0.05]。4、就安全性而言,來那度胺組的不良反應(yīng)主要表現(xiàn)在血液學(xué)毒性作用[OR=1.98,95%CI(1.77,2.21),P0.05],主要包括貧血、中性粒細胞減少、血小板減少等(P=0.0003,P0.00001,P0.0001,P值均小于0.05);非血液學(xué)毒性反應(yīng)無統(tǒng)計學(xué)意義[OR=1.06,95%CI(0.91,1.23),P=0.44,P0.05],且來那度胺組神經(jīng)系統(tǒng)癥狀明顯發(fā)生率低(P=0.00001)。結(jié)論:1、含來那度胺的聯(lián)合化療能提高初診MM患者的CR/VGPR率和OR率;2、含來那度胺的聯(lián)合化療能延長初診MM的PFS(1年和20個月),但未表明能使其OS獲益;3、含來那度胺的聯(lián)合化療安全性高,不良反應(yīng)主要是血液學(xué)毒性方面,且神經(jīng)系統(tǒng)病變風險低;4、含來那度胺的聯(lián)合化療是治療初診MM患者的理想用藥。
[Abstract]:Objective: to evaluate the efficacy and safety of publicly published combined chemotherapy with renatamine in the treatment of newly diagnosed multiple myeloma. Methods: the Chinese and English databases such as CNKI, Chinese biomedical abstracts, Wanfangli, Wanfangli, Weipu.com were used to search the Chinese and English databases. The limited time limit for retrieval was from 2005 to January 2017. Search keywords: newly diagnosed multiple myeloma or the untreated multiple myeloma, newly diagnosed multiple myeloma or the untreated multiple myeloma, immunomodulator Immune modulator, and so on. To search the published literature on clinical trials of renalidomide combined with chemotherapy in the treatment of newly diagnosed MM patients, and to extract data on remission rate and adverse drug reactions. Rev Man5.3 software was used to evaluate and analyze the combined effect. Results: a total of 6 articles were included. 1621 participants were involved in the study, 848 in the Leridomide group and 773 in the control group. [ORA 2.25 ~ 95CIQ 1.81 ~ 2.79 ~ (1) P0.00001 / P0.05 ~ (1.744) ~ (95) CIQ 1.40 ~ 1.2.16 ~ + P0.00001p0.05] .3. in comparison with the control group for 1 and 20 months of OS, the control group was compared with the control group in terms of OS for one year and 20 months. Thrombocytopenia (P0. 0003), P0. 0001, P0. 0001, P < 0. 05, and non-hematological toxic reactions were not statistically significant [OR1. 06 + 95 + CI 0. 01 1 1. 23P0. 44P 0. 05], and the incidence of nervous system symptoms was significantly lower in the laminadine group (P 0. 00001) than that in the control group (P < 0. 05). ConclusionThe combination chemotherapy with genadamide can increase the CR/VGPR rate and OR rate of the newly diagnosed MM patients by 2%, and the combination chemotherapy with Lenadamide can prolong the PFSs of the newly diagnosed MM patients (1 year and 20 months), but it is not shown that the combination chemotherapy can benefit the OS of the patients with newly diagnosed MM. High safety in combination with chemotherapy, The adverse reactions were mainly hematological toxicity, and the risk of neuropathy was low. The combined chemotherapy containing renatamine was an ideal drug for the treatment of newly diagnosed MM patients.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.3

【參考文獻】

相關(guān)期刊論文 前4條

1 侯健;杜欣;金潔;蔡真;陳方平;周道斌;于力;克曉燕;李曉;吳德沛;孟凡義;艾輝勝;Jingshan Zhang;Honeylet Wortman-Vayn;Nianhang Chen;Jay Mei;王健民;;一項有關(guān)來那度胺聯(lián)合低劑量地塞米松治療中國復(fù)發(fā)/難治性多發(fā)性骨髓瘤患者的多中心、開放性Ⅱ期臨床試驗:MM-021試驗(全譯文)[J];臨床血液學(xué)雜志;2014年05期

2 呂曉偉;徐冬;王魯群;;多發(fā)性骨髓瘤的分子生物學(xué)特性及靶向治療對策[J];醫(yī)學(xué)與哲學(xué)(B);2013年02期

3 克曉燕;王艷芳;楊玉花;王魯華;;多發(fā)性骨髓瘤的過去、現(xiàn)在及未來[J];中國實驗血液學(xué)雜志;2008年02期

4 宋麗潔;封宇飛;傅得興;胡欣;王唯紅;;新型免疫調(diào)節(jié)藥來那度胺的藥理及臨床研究進展[J];中國新藥雜志;2006年21期

，

本文編號：1775103