龚辉.CD方案治疗初治多发性骨髓瘤患者疗效观察及预后分析[J].内科急危重症杂志,2019,25(5):397-400
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| DOI：10.11768/nkjwzzzz20190513 |
| 中文关键词: 多发性骨髓瘤 细胞遗传学异常 硼替佐米 疗效 预后 |
| 英文关键词: |
| 基金项目:深科技创新2017（No:131） |
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| 摘要点击次数: 2052 |
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| 中文摘要: |
| 目的: 探讨初发多发性骨髓瘤(MM)患者的细胞遗传学异常和硼替佐米联合环磷酰胺、地塞米松( BCD方案)治疗的临床疗效。方法：收集48例初发MM患者的临床资料，取患者骨髓细胞培养采用R显带技术行染色体核型分析，用DNA序列探针进行基因(1q21扩增、13q14、p53缺失、IGH重排)分析，患者均采用BCD联合化疗方案治疗并于2、4、6个周期分析疗效；分析总体疗效及细胞遗传学异常患者的疗效和生存情况。结果：48例MM患者中，细胞遗传学异常29例（60.42%）；13q14的检出率为37.5%（18/48），P53缺失的检出率为14.58%（7/48），1q21 扩增检出率为41.67%（20/48），IgH重排检出率为35.42%（17/48）。大部分患者在2个疗程后开始显效，随疗程增加疗效明显，6个疗程后21例（43.75%）完全缓解(CR)，总有效率为81.25%（39/48）；细胞遗传学正常患者CR率为84.21%，总有效率(ORR)89.47%，核型异常、13q14、P53缺失、1q21 扩增、IgH重排患者的CR率和总有效率均低于正常患者（P<0.05）,治疗过程不良事件均可耐受。结论:细胞遗传学异常可影响BCD方案治疗初发MM的疗效及预后，初发MM患者做细胞遗传学检测对指导临床治疗有一定的帮助。 |
| 英文摘要: |
| Objective: To investigate the cytogenetic abnormalities of patients with newly diagnosed multiple myeloma (MM) and the clinical efficacy of bortezomib combined with cyclophosphamide and dexamethasone (BCD regimen). Methods: The clinical data of 48 patients with newly diagnosed MM admitted to our hospital were collected. The patient's bone marrow cells were cultured by R-banding technique for karyotype analysis, and DNA sequence probes were used for gene analysis (1q21 amplification, 13q14, p53 deletion, IGH rearrangement). A11 patients received BCD chemotherapy and the therapeutic efficacy was investigated at cycle 2, 4 and 6. Moreover, the therapeutic efficacy and long-term survival data were analyzed among the patients with different types of cytogenetic abnormalities. Results: Among 48 patients with MM, there were 29 cases (60.42%) of abnormal karyotype, 18 cases (37.5%) of abnormal 13q14, 20 cases (41.67%) of abnormal 1q21 amplification, 17 cases (35.42%) of abnormal IgH rearrangement. Most of the patients started to be effective after 2 courses of treatment, and the curative effectiveness was obvious with the course of treatment. After 6 courses of treatment, 21 cases obtained complete remission (CR) (43.75%, 21/48), and the total effective rate was 81.25% (39/48). The CR in normal karyotype patients was 84.21%, and the total effective rate (ORR) was 89.47%. As compared with normal controls, the CR and total effective rate in patients with abnormality karyotype, 13q14, P53 deletion, 1q21 amplification, IgH rearrangement were significantly reduced as compared with those with normal karyotype (P<0.05). The adverse reactions in the treatment process were tolerable. Conclusion: The cytogentic abnormalities can influence the efficacy and prognosis of newly diagnosed MM patients treated with BCD regimen. The detection of cytogenetic abnormalities has a certain reference value for the treatment of primary MM. |
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