波替单抗治疗伴或不伴有肾功能不全的老年多发性骨髓瘤

Bortezomib-based chemotherapy in elderly multiple myeloma patients with or without abnormal renal function

【摘要】目的 通过回顾性分析波替单抗（硼替佐米）为主的化疗方案治疗老年多发性骨髓瘤（MM）患者的治疗结果，探讨其治疗效果、不良反应及对合并肾功能不全患者的疗效。方法 对2007年1月至2012年12月在解放军总医院第一附属医院住院治疗的46例老年MM患者进行回顾性分析，依据肾功能是否正常将患者分为肾功能不全组14例，肾功能正常组32例；依据是否初治分为初治组25例，复治组21例。分别采用波替单抗为主的化疗方案治疗，比较各组患者治疗2个疗程及4个疗程后的总反应率（ORR），并统计治疗后的相关不良反应。结果 46例患者中，治疗2个疗程后初治组ORR为88.0%（22/25），复治组ORR为76.2%（16/21），但差异无统计学意义（P＞0.05）。4个疗程后初治组ORR为90.0%（9/10），复治组ORR为75.0%（15/20），两组间差异有统计学意义（P＜0.01）。完成4个疗程时肾功能不全组ORR为90.9%（10/11），肾功能正常组ORR为73.7%（14/19），两组间差异无统计学意义（P＞0.05）。治疗相关的不良反应包括末梢神经炎、胃肠道反应、血小板减少等，对症处理后均可控制。结论 波替单抗为主的化疗方案治疗老年MM患者疗效显著，疗效随疗程增加逐渐提高。对于合并肾功能不全老年患者，尽早使用波替单抗为主的化疗方案，可纠正肾功能不全，改善患者生活质量。含波替单抗的化疗方案在该组老年患者治疗中有较好的安全性。

基金项目:[e-mail]

【Abstract】Objective To observe the efficacy and adverse reactions of bortezomib-based chemotherapy in the treatment for elderly multiple myeloma (MM) and MM with abnormal renal function through retrospective analysis. Methods A total of 46 MM patients with a median age of 69 years (ranging from 60 to 75 years) in the First Affiliated Hospital of Chinese PLA General Hospital from January 2007 to December 2012 were enrolled in this retrospective study. They were divided into 2 groups based on their renal function, abnormal renal function group (n＝14) and normal renal function group (n＝32), and also assigned into newly diagnosis group (n＝25) and retreatment group (n＝21). They all received a bortezomib-based chemotherapeutic regimen. The overall reaction rate (ORR) was compared between different groups after 2 or 4 courses of treatment. The related adverse reactions were recorded. Results Among 46 patients, the ORR was 88.0% (22/25) and 76.2%(16/21) respectively in newly diagnosis group and retreatment group after 2 courses of treatment (P＞0.05), and was 90.0% (9/10) and 75.0%(15/20) respectively after 4 courses, with significant difference between the 2 groups (P＜0.01). The ORR was 90.9% (10/11) and 73.7%(14/19) respectively for abnormal renal function group and normal renal function group after 4 courses of treatment, and there was no significant difference between them (P＞0.05). The related adverse reactions were mainly peripheral neuritis, gastrointestinal tract reaction, thrombocytopenia, etc, and were all well controlled after symptomatic treatment. Conclusion The efficacy of bortezomib-based regimen is favorable in the treatment of the elderly patients with MM; and with the increase of treatment courses, the efficacy is enhanced. For those with renal insufficiency, bortezomib should be used as early as possible to correct renal dysfunction and improve patient’s quality of life. The bortezomib-based chemotherapeutic regimen is of quite safety for the elderly with MM.