李 宁, 张 力①, 宋永平②, 罗素霞, 房佰俊②. 硼替佐米联合多柔比星脂质体有效治疗复发难治性多发性骨髓瘤*[J]. 中国肿瘤临床, 2010, 37(15): 875-878. DOI: 10.3969/j.issn.1000-8179.2010.15.009
引用本文: 李 宁, 张 力①, 宋永平②, 罗素霞, 房佰俊②. 硼替佐米联合多柔比星脂质体有效治疗复发难治性多发性骨髓瘤*[J]. 中国肿瘤临床, 2010, 37(15): 875-878. DOI: 10.3969/j.issn.1000-8179.2010.15.009
LI Ning1, ZHANG Li2, SONG Yongping3, LUO Suxia1, FANG Baijun3. Combined Pegylated Liposomal Doxorubicin plus Bortezomib is Highly Effective in Patients with Relapsed or Refractory Multiple Myeloma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(15): 875-878. DOI: 10.3969/j.issn.1000-8179.2010.15.009
Citation: LI Ning1, ZHANG Li2, SONG Yongping3, LUO Suxia1, FANG Baijun3. Combined Pegylated Liposomal Doxorubicin plus Bortezomib is Highly Effective in Patients with Relapsed or Refractory Multiple Myeloma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(15): 875-878. DOI: 10.3969/j.issn.1000-8179.2010.15.009

硼替佐米联合多柔比星脂质体有效治疗复发难治性多发性骨髓瘤*

Combined Pegylated Liposomal Doxorubicin plus Bortezomib is Highly Effective in Patients with Relapsed or Refractory Multiple Myeloma

  • 摘要: 目的:硼替佐米(bortezo mib)是一种高效、可逆性蛋白酶体抑制剂,通过诱导骨髓瘤细胞的凋亡,在初治多发性骨髓瘤(multiple myeloma,MM)患者的治疗中发挥良好的疗效。本研究旨在观察硼替佐米联合多柔比星脂质体(pegylated liposomal doxorubicin ,PLD )治疗复发、难治性多发性骨髓瘤的疗效和不良反应,以及该方案在肾功能不全患者中应用的安全性。方法:以2006年1 月至2007年12月间于河南省肿瘤医院肿瘤内科诊断的8 例复发、难治性MM患者为研究对象,采用硼替佐米(1.3mg/m2第1、4、8、11天分别静脉注射)联合PLD(20mg/m2第4 天静脉滴注)方案治疗,每3 周为1 个疗程。每例患者接受2~4 个疗程的治疗。采用EBMT 标准评价疗效,按美国国立癌症研究所的第三版常规毒性判定标准评价不良反应。结果:全组中位随访12个月,总有效率87.5%(7/8),其中3 例患者接近完全缓解,4 例部分缓解,1 例无变化。中位肿瘤进展时间(TTP)10个月(95%CI:6.54~13.46)。 4 例合并肾功能不全的患者与肾功能正常患者的疗效相近。Ⅰ~Ⅱ级不良反应主要包括周围神经病变(8/8,100%)、乏力(7/8,87.5%)、腹泻(5/8,62.5%)、中性粒细胞减少(6/8,75.0%)、血小板减少(6/8,75.0%);Ⅲ~Ⅳ级不良反应主要包括乏力(1/8,12.5%)、中性粒细胞减少(2/8,25.0%)、血小板减少(2/8,25.0%)。 所有不良反应经对症治疗或适当推迟化疗后均可恢复。结论:对于复发、难治性MM,硼替佐米联合PLD 不失为一种有效的挽救性治疗方案,且不良反应易于处理,在合并肾功能不全的患者可安全应用。

     

    Abstract: Objective:To investigate the efficacy and adverse events of bortezomib in combination with pegylated lipo -somal doxorubicin (PLD) in 8 patients with relapsed or refractory multiple myeloma and to evaluate the safety of this regi-men in the patients concurrently with renal impairment.Methods:From January2006to December 2007in the Department of Medical Oncology, Henan Cancer Hospital, 8 patients with relapse or refractory multiple myeloma received bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11in combination with PLD 20mg/m2 on day4, followed by a 10-day rest period regimen. The regimen was repeated for 2- 4 cycles. The European Group for Blood and Marrow Transplant (EMBT) response criteria was used to assess the response. Adverse events were graded according to the National Cancer Institute Common Termi-nology Criteria for Adverse Events (NCICTCAE, version 3.0). Results: During the follow-up duration with a median of12 months, 87.5% (7/8) patients responded to the treatment, including nearly complete response in 3 (37.5%) patients, partial response in 4 (50%) patients and no response in1 (12.5%) patient. The median time of disease progression (TTP) was10 months (95% CI, 6.54-13.46). The response rates of the patients with and without renal impairment were similar ( 100 % vs.75% ,P>0.05), and the renal function in the patients with renal impairment was improved during chemotherapy. The most common adverse events (grade Ⅰ- Ⅱ) included peripheral neuropathy (8/8, 100 %), fatigue (7/8, 87.5%), diarrhea (5/8, 62.5%), neutropenia (6/8, 75%), and thrombocytopenia (6/8, 75%), whileⅢ- Ⅳadverse events included mainly fatigue ( 1/8, 12.5%), neutropenia (2/8, 25%), and thrombocytopenia (2/8, 25%). All these adverse events could be relieved by symp-tomatic treatment or by delaying chemotherapy. Conclusion:Bortezomib in combination with PLD, given on a21-day sched ule, is an effective, new, and safe salvage therapy with manageable toxicity in patients with relapsed or refractory multiple myeloma. The adverse events can be tolerated in most patients, and this regimen is also safe in the patients with renal impairment.

     

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