皮下注射硼替佐米为主化疗方案治疗多发性骨髓瘤
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摘要
目的探讨皮下注射硼替佐米为主化疗方案治疗多发性骨髓瘤患者的临床疗效及安全性。方法分析2013年7月至2017年7月MM患者74例,接受P-CTD方案(硼替佐米、环磷酰胺、沙利度胺、地塞米松)进行治疗,观察组硼替佐米皮下注射37例,对照组硼替佐米静脉注射37例。上述患者共接受6个疗程的治疗,治疗结束后评估临床疗效及不良反应。结果观察组总有效率为94.6%,对照组总有效率为91.9%,差异无统计学意义(P>0.05);观察组血液学毒性血小板减少发生率和周围神经病变发生率均低于对照组,差异均有统计学意义(P<0.05)。结论皮下注射硼替佐米为主治疗初治、复发难治多发性骨髓瘤患者是一种安全、可靠、有效、耐受性好的方法。
Objective To investigate the safety and efficacy of subcutaneous administration of bortezomib based chemotherapy in the treatment for multiple myeloma. Methods 74 patients with multiple myeloma were selected from July 2013 to July 2017 in our hospital, who had received P-CTD( bortezomib,cyclophosphamide, Thalidomide, dexamethasone) regimen. 37 cases were randomly chosen as the observation group and another 37 cases the control group.The observation group was administrated with bortezomib subcutaneously, and the control group was was administrated with bortezomib by intravenous injection. Both groups received a total of 6 cycles of treatment. The clinical efficacy and safety between the two groups were compared.Results The overall response rate of the observation group was 94.6%,and the overall response rate of the control group was 91.9%,the difference was not statistically significant(P>0.05).The thrombocytopenia occurrence rate in patients and peripheral nerve lesions incidence of observation group was significantly lower than that of control group( P <0.05). Conclusions Subcutaneous administration of bortezomib based chemotherapy in patients with initial, relapsed or refractory multiple myeloma is the regimen of safety, reliability, effectiveness and better-tolerance.
Objective To investigate the safety and efficacy of subcutaneous administration of bortezomib based chemotherapy in the treatment for multiple myeloma. Methods 74 patients with multiple myeloma were selected from July 2013 to July 2017 in our hospital, who had received P-CTD( bortezomib,cyclophosphamide, Thalidomide, dexamethasone) regimen. 37 cases were randomly chosen as the observation group and another 37 cases the control group.The observation group was administrated with bortezomib subcutaneously, and the control group was was administrated with bortezomib by intravenous injection. Both groups received a total of 6 cycles of treatment. The clinical efficacy and safety between the two groups were compared.Results The overall response rate of the observation group was 94.6%,and the overall response rate of the control group was 91.9%,the difference was not statistically significant(P>0.05).The thrombocytopenia occurrence rate in patients and peripheral nerve lesions incidence of observation group was significantly lower than that of control group( P <0.05). Conclusions Subcutaneous administration of bortezomib based chemotherapy in patients with initial, relapsed or refractory multiple myeloma is the regimen of safety, reliability, effectiveness and better-tolerance.
引文
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[10]中国医师协会血液科医师分会多发性骨髓瘤专业委员会.多发性骨髓瘤周围神经病变诊疗中国专家共识[J].中华内科杂志,2015,54(9):821-824.
[11]TEICHER B A,TOMASZEWSKI J E.Proteasome inhibitors[J]. Biochem Pharmacol,2015,96(1):1-9.
[12] RICHARDSON P G,DELFORGE M,BEKSAC M,et al.Management of treatment-emergent peripheral neuropathy in multiple myeloma[J].Leukemia,2012,26(4):595-608.
[13]MORAWSKA M,GRZASKO N,KOSTYRA M,et al.Therapy-related peripheral neuropathy in multiple myeloma patients[J]. Hematol Oncol,2015,33(4):113-119.
[14] HAN X,WANG L,SHI H,et al.Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced?peripheral neuropathy in patients with?multiple myeloma[J].BMC Cancer,2017,17(1):40.
[2] TIAN Z,D'ARCY P,WANG X,et al.A novel small molecule inhibitor of deubiquitylating enzyme USP14 and UCHL5 induces apoptosis in multiple myeloma and overcomes bortezomib resistance[J]. Blood,2014,123(5):706-716.
[3] ZHOU W,AN G,JIAN Y,et al.Effect of CYP2C19 and CYP3A4 gene polymorphisms on the efficacy of bortezomib-based regimens in patients with multiple myeloma[J]. Oncol Lett,2015,10(2):1171-1175.
[4] MORAWSKA M,GRZASKO N,KOSTYRA M,et al.Therapy-related peripheral neuropathy in multiple myeloma patients[J]. Hematol Oncol,2015,33(4):113-119.
[5] BURKHART T,KEITH MCL,LENNEMAN CAG,et al.Bortezomib-Induced cardiac Tamponade in a 49-year-old man[J]. Tex Heart Inst J,2018,45(4):260-263.
[6] MOREAU P,PYLYPENKO H,GROSICKI S,et al.Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma:A randomised,phase 3,non-inferiority study[J]. Lancet Oncol,2011,12(5):431-440.
[7] XU Y,DENG S,MAO X,et al.Tolerance,kinetics,and depth of response for subcutaneous versus intravenous administration of bortezomib combination in chinese patients with newly diagnosed multiple myeloma[J]. Clin Lymphoma Myeloma Leuk,2018,18(6):422-430.
[8] DURIE BG,HAROUSSEAU JL,MIGUEL JS,et al.International uniform response criteria for multiple myeloma[J].Leukemia,2006,20(9):1467-1473.
[9] U.S.Department of Health and Human Services,National Institutes of Health,National Cancer Institute.Common Terminology Criteria for Adverse Events(CTCAE)v4.0[EB/OL].2009(2010-06-14).http://evs.nci.nih.gov/ftp1/CTCAE/About.html.
[10]中国医师协会血液科医师分会多发性骨髓瘤专业委员会.多发性骨髓瘤周围神经病变诊疗中国专家共识[J].中华内科杂志,2015,54(9):821-824.
[11]TEICHER B A,TOMASZEWSKI J E.Proteasome inhibitors[J]. Biochem Pharmacol,2015,96(1):1-9.
[12] RICHARDSON P G,DELFORGE M,BEKSAC M,et al.Management of treatment-emergent peripheral neuropathy in multiple myeloma[J].Leukemia,2012,26(4):595-608.
[13]MORAWSKA M,GRZASKO N,KOSTYRA M,et al.Therapy-related peripheral neuropathy in multiple myeloma patients[J]. Hematol Oncol,2015,33(4):113-119.
[14] HAN X,WANG L,SHI H,et al.Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced?peripheral neuropathy in patients with?multiple myeloma[J].BMC Cancer,2017,17(1):40.