多发性骨髓瘤的临床特征及疗效分析

【】　目的　探讨多发性骨髓瘤的临床特征及不同方案的疗效。　方法　回顾性分析2006年2月-2010年8月110例多发性骨髓瘤的临床特征及治疗情况，对不同方案的疗效进行比较。　结果　110例患者中Ⅲ期73例，40例伴发有基础疾病；24例接受MP方案，部分缓解10例，无变化1例，疾病进展8例，总有效率41.7%；其余86例接受联合化学疗法的患者完全缓解18例，部分缓解17例，轻微缓解30例，无变化17例，疾病进展4例，总有效率40.7%；两组总有效率差异无统计学意义（P<0.05）。联合化疗中PAD方案的总有效率最高，为62.5%。110例患者的中位生存期32.6个月，3年生存率为34.5%，加入沙利度胺组，总有效率为35.8%，3年生存率36.5%，联合硼替佐米治疗组总有效率为75%。　结论　多发性骨髓瘤患者多为晚期，有基础疾病，化疗后易感染，联合化疗组的有效率较MP方案高，但两组的总生存率无差异，加用新药沙利度胺或硼替佐米可以提高有效率。【Abstract】　Objective　Toanalyzetheclinicalcharacteristicsandclinicaloutcomesofpatientswithmultiplemyelomatreatedwithdifferentregimens.　Methods　Weretrospectivelyanalyzedtheclinicalcharacteristicsandtreatmentsof110patientswithmultiplemyelomatreatedbetweenFebruary2006andAugust2010,andcomparedtheclinicaloutcomesofdifferenttreatmentregimens.　Results　Seventy-threeoutofthe110patientswereatstageⅢ,and40patientshadoneortwomorefundamentaldiseases.Twenty-twopatientsreceivedMPregimen,amongwhom10gainedpartialalleviation,1hadnochangeand8wereaggravatedwithatotaleffectiverateof41.7%.Another86casesreceivedcombinationchemotherapy,andamongthem,18gainedcompletealleviation,17attainedpartialalleviation,30achievedmildalleviation,17hadnochange,and4wereaggravatedwithatotaleffectiverateof40.7%.Intermsofthetotaleffectiverate,therewasnostatisticaldifferencebetweenthesetwogroups.PAD-treatedgrouphadahighesteffectiverateof62.5%.Themediansurvivaltimeforallthepatientswas32.6months;3-yearsurvivalratewas34.5%.Forpatientstreatedwiththalidomide,thetotaleffectiverateand3-yearsurvivalratewere35.8%and36.5%respectively,whileforpatientstreatedwithbortezomib,theeffectiveratewas75%.　Conclusions　Patientswithmultiplemyelomaatalatestagecomplicatedwithfundamentaldiseasescandevelopinfectionsafterchemotherapy.TotaleffectiverateofcombinationchemotherapyishigherthanthatofMPtreatment,butsurvivalrateofthetwotreatmentshavenostatisticaldifference.Theeffectiveratecanbeincreasedaftertheusingofnovelagentssuchasthalidomideandbortezomib.