刘宪凯 吕国庆 杨满 吴隼

[摘要] 目的 探讨来那度胺、三氧化二砷及维生素C治疗复发/难治性多发性骨髓瘤的疗效及安全性。 方法 回顾性分析2013年8月～2017年4月期间来我院治疗的43例复发/难治性多发性骨髓瘤患者的临床资料，依治疗方案分为治疗组（20例，来那度胺+三氧化二砷+维生素C方案）与对照组（23例，TD方案），比较两组疗效及安全性。 结果 治疗组化疗3周期后的总缓解率（65.0%）大于对照组的34.8%（P=0.048），且治疗组可以达到更深程度的缓解（P=0.034）；胃肠道反应、周围神经病变、骨髓抑制、血栓的累计发生率差异无统计学意义（P>0.05）；治疗组感染、血压波动、血糖波动的累计发生率低于对照组，差异有统计学意义（P<0.05）；治疗组心脏毒性的累计发生率高于对照组，但差异无统计学意义（P=0.098）。 结论 来那度胺、三氧化二砷及维生素C方案治疗复发/难治性多发性骨髓瘤疗效明显，具有耐受性好、不良反应轻的特点，对合并基础疾病的老年患者亦有较好的疗效。

[关键词] 来那度胺；三氧化二砷；维生素C；复发/难治性多发性骨髓瘤

[中图分类号] R733.3 [文献标识码] A [文章编号] 1673-9701（2018）02-0016-04

[Abstract] Objective To investigate the efficacy and safety of lenalidomide， arsenic trioxide and vitamin C in the treatment of relapsed/refractory multiple myeloma. Methods The clinical data of 43 patients with relapsed/refractory multiple myeloma treated in our hospital from August 2013 to April 2017 were retrospectively analyzed. The patients were divided into treatment group（n=20， lenalidomide+arsenic trioxide+vitamin C program） and control group（n=23， TD program）. The efficacy and safety between the two groups were compared. Results The total remission rate in the treatment group after 3 cycles of chemotherapy was 65.0%， which was significantly higher than that in the control group（34.8%， P=0.048）， and the treatment group could reach a deeper degree of remission（P=0.034）. There was no statistically significant difference in the cumulative incidences of gastrointestinal reactions， peripheral neuropathy， myelosuppression and thrombus （P>0.05）. The cumulative incidence of infection， fluctuation of blood pressure and blood glucose in the treatment group was lower than that in the control group， and the difference was significant（P<0.05）. The cumulative incidence of cardiotoxicity was higher in the treatment group than that in the control group， but the difference was not statistically significant （P=0.098）. Conclusion The lenalidomide， arsenic trioxide and vitamin C regimens are effective in the treatment of relapsed/refractory multiple myeloma. They are well tolerated and have mild adverse reactions. They are also effective in elderly patients with underlying diseases.

[Key words] Lenalidomide； Arsenic trioxide； Vitamin C； Recurrent/refractory multiple myeloma

多發性骨髓瘤（multiple myeloma，MM）是一种浆细胞恶性克隆性肿瘤，其发病率约占血液系统恶性肿瘤的10%，好发于中老年人，随着年龄的增长，发病率呈逐渐上升的趋势。随着医疗水平的发展，由传统的化疗方案、大剂量化疗后序贯造血干细胞移植、靶向药物的迅速发展，MM已经取得良好疗效，但仍面临着复发问题，对于复发/难治性MM的最佳治疗方案仍未明确。本研究采用来那度胺、三氧化二砷及维生素C方案治疗复发/难治性MM患者，进行临床观察及分析，进一步探讨该方案的有效性和安全性，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2013年8月～2017年4月本院收治的43例复发/难治性MM患者，其中男24例，女19例；中位年龄59（48～69）岁。Ⅱ期……