苏铭俊+张呈+容庭杰

[摘要] 目的 观察评价小剂量沙利度胺联合改良VCMP（长春新碱、环磷酰胺、马法兰、泼尼松）与VAD（长春新碱、阿霉素、地塞米松）方案治疗老年多发性骨髓瘤（MM）的疗效及毒副反应。 方法 选择本院2012年1月～2016年2月共有45例初诊的老年多发性骨髓瘤患者纳入研究，随机分两组，分别应用小剂量沙利度胺联合改良VCMP方案治疗的患者23例（TD+mVCMP组），应用小剂量沙利度胺联合VAD方案治疗的患者22例（TD+VAD组），两组服用沙利度胺均为100mg/d。每例患者均接受4个疗程以上治疗后评价。 结果 TD+mVCMP组23例患者中完全缓解4例，部分缓解15例，有效率为82.6%；TD+VAD组22例患者中完全缓解2例，部分缓解10例，有效率为55.5%。两组有效率比较，差异有统计学意义（P<0.05）。TD+mVCMP组和TD+VAD两组治疗前后血红蛋白及血红蛋白显著得到改善，差异有统计学意义（P<0.05）。此外，与TD+VAD组相比，TD+mVCMP组治疗后的血红蛋白和白蛋白都显著升高，差异具有统计学意义（P<0.05）。TD+mVCMP组出现血液学变化、消化道症状及周围神经病变不良反应的病例分别为4、3、2例，则不良反应率为39.1%。TD+VAD组出现血液学变化、消化道症状及周围神经病变不良反应的病例分别为7、5、4例，则不良反应率为72.8%。两组有效率比较，差异有统计学意义（P<0.05）。 结论 小剂量沙利度胺联合改良VCMP（长春新碱、环磷酰胺、马法兰、泼尼松）为治疗MM可行且有效的方案，造血功能得到改善，貧血缓解，并且不良反应率低于VAD（长春新碱、阿霉素、地塞米松）方案。

[关键词] 沙利度胺；VCMP；VAD；老年多发性骨髓瘤

[中图分类号] R733.3 [文献标识码] A [文章编号] 2095-0616（2017）06-27-04

[Abstract] Objective To observe and evaluate thetherapeutic efficacy and side effects of low dose thalidomide combined with modified VCMP （vincristine，cyclophosphamide，Ma Falan，prednisone） and VAD （vincristine，doxorubicin and dexamethasone） in treatment of multiple myeloma （MM） in the elderly. Methods 45 cases of newly diagnosed multiple myeloma patients cured in our hospital from January 2012 to February 2016 were selected and randomly divided into TD+mVCMP group （treated with low dose thalidomide combined with modified VCMP protocol of 23 cases） and TD+VAD group （ treated with low dose thalidomide combined with VAD regimen of 22 cases）.Thalidomide was 100mg/d in the two groups.Each patient was treated with more than 4 courses of treatment.The curative effect was evaluated. Results Among 23 patients in TD+mVCMP group，there were 4 cases of complete remission，15 cases of partial remission，and the effective rate was 82.6%.Among the 22 patients in TD+VAD group，there were 2 cases of complete remission，10 cases of partial remission， and the effective rate was 55.5%.The difference of effective rate between the two groups was statistically significant（P<0.05）.Hemoglobin and hemoglobin were significantly improved before and after treatment of TD+mVCMP group and TD+VAD group，the difference was statistically significant（P<0.05）.In addition，compared with the TD+VAD group，the hemoglobin and albumin of TD+mVCMP group after treatment were significantly increased，the difference was statistically significant（P<0.05）.The distribution of adverse reactions of hematological changes，gastrointestinal symptoms and peripheral neuropathy was 4，3 and 2 cases，respectively in TD+mVCMP group. The adverse reaction rate was 39.1%. The distribution of adverse reactions of hematological changes，gastrointestinal symptoms and peripheral neuropathy was 7， 5 and 4 cases，respectively in TD+VAD group.The adverse reaction rate was 72.8%.Compared the efficiency between the two groups，the difference was statistically significant（P<0.05）. Conclusion Low dose thalidomide combined with modified VCMP （vincristine，cyclophosphamide，Ma Falan，prednisone）is a feasible and effective solution for MM.Hematopoietic function is improved and anemia relieves.The adverse reaction rate was lower than that of VAD （vincristine，doxorubicin and dexamethasone）.

[Key words] Thalidomide； VCMP； VAD； Senile multiple myeloma

多发性骨髓瘤（multiple myeloma，MM）是一种起源于B细胞系的恶性肿瘤，其特征为产生单克隆免疫球蛋白的异常浆细胞增多，并在骨髓内恶性增殖，引起骨折和骨髓功能衰竭，产生临床症状[1]。目前，多发性骨髓瘤的治疗上有了很大的进步，但多发性骨髓瘤仍然不能治愈[2-3]。本研究选取45例初诊的老年多发性骨髓瘤患者评价小剂量沙利度胺联合改良VCMP（长春新碱、环磷酰胺、马法兰、泼尼松）与VAD（长春新碱、阿霉素、地塞米松）方案治疗老年多发性骨髓瘤（MM）的疗效及毒副反应，为临床推广提供理论支持。

1 资料与方法

1.1 一般资料

本研究于2012年1月～2016年2月招募医院住院部45例初诊的老年多发性骨髓瘤患者纳入研究，其中男21例，女24例，均为出诊，无研究用药史。……