摘要
目的 :探讨反应停治疗复发和难治性多发性骨髓瘤的临床疗效和治疗前后血清VEGF水平的变化。方法 :用自身前 -后对照研究设计方案。 14例复发和难治性多发性骨髓瘤分别用MP方案 (马法兰 0 2mg/kg·日 ,强的松 1 0mg/kg·日 ,连续使用 4天为一疗程 )、VMCP方案 (长春新碱 2mg第一天静脉缓慢推注 ,环磷酰胺6 0 0mg/m2 第一天静脉滴注 ;马法兰 0 2mg/kg·日、强的松 1 0mg/kg·日连续服用 4天 )或VAD方案 (长春新碱0 5mg/天、阿霉素 10mg/天 ,缓慢静脉滴注 ,连续使用 4天 ;地塞米松 4 0mg/天 ,连续服用 4天 )治疗 ,作为对照。第二阶段 (复发难治阶段 )治疗即上述 14例患者再分别单用反应停 ,先从 2 0 0mg/天开始使用 ,一周后逐渐增加剂量至 6 0 0mg/天 ,连续使用 3到 6个月后作临床疗效评价。在使用反应停治疗前和治疗后 3月与 6月分别测定每一例患者血清中血管内皮生长因子 (VEGF)水平。结果 :1例患者使用反应停后出现全身明显皮疹而停药。13例分别用MP方案、VMCP方案或 /和VAD方案治疗无效的复发和难治性多发性骨髓瘤患者在使用反应停治疗 3至 6个月后 ,2例获得部分缓解、 6例出现进步、 5例仍然无效 ,总有效率为 6 1 5 % ;如将退出治疗的一例视为无效 ,则总有效率为 5 7% (P <0 0 0 0 1)。
Objective:To evaluate the effectiveness and side-effects of thalidomide from the treatment of refractory and relapsed multiple myeloma(RRMM),and to investigate the levels of vascular endothelial growth factor(VEGF)of RRMM before and after treatment with thalidomide.Method:A before-after study in the same patient was applied.The treatment with MP(melphalan 0.2mg/kg daily and oral prednisone 1.0mg/kg daily for four days)or VMCP(vincristine 2.0mg given intravenously slowly on the first day;cyclophosphamide 600mg/m 2 administered intravenously on the first day;melphalan 0.2mg/kg daily and the oral prednisone 1.0mg/kg daily for 4 days)or VAD (vincristine 0.5mg daily,doxorubicin 10mg daily,administered intravenously slowly for 4 days;dexamethasone 40mg daily,intravenously for 4 days) was defined as the first treatment phase in the fourteen patients with RRMM.The second therapeutic phase was carried out to treat these patients with a regimen of thalidomide 200mg daily at first,increasing the dosage gradually after one week up to 600mg daily,and the effectiveness and side-effects of the treatment with thalidomide in these patients with RRMM after six months were evaluated,and we tested the serum levels of VEGF at 0,3 and 6 months after treatment with thalidomide.Statistical software STATA 5.0 was employed to perform the analysis of the data by paired Chi-square test.Result:Thirteen cases could be analyzed except one patient who was withdrawn from the study because of severe skin rash after administering thalidomide.The therapeutic scheme with thalidomide displayed 2 cases having complete remission(2/13),6 cases had partial remission(6/13) and 5 cases with no response.The difference between the effectiveness of these two therapeutic regimens in the thirteen patients with RRMM showed a statistical significance by paired Chi-square test with a total response rate 57% in thalidomide group(P<0.0001).The serum level of VEGF was 397.52±15.34pg/ml (267.64～823.71pg/ml)before treatment with thalidomide.It was 269.18±13.72pg/ml(198.37～633.19pg/ml) (P<0.05)after 3 months and that was 186.43±10.22pg/ml(123.35～324.66pg/ml)(P<0.001)after six months.Two patients suffered from somnolence,three tolerable by all pattents.Subjects had slight edema at their lower extremities and three patients had constipation after taking thalidomide,but they were.Conclusion:Administering thalidomide to treat the patients with RRMM showed significant effectiveness and mild side-effects.After treatment with thalidomide the serum level of VEGF showed marked deerease.
出处
《华西医学》
CAS
2003年第4期495-498,共4页
West China Medical Journal
