VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析

doi:10.3969/j.issn.1671-2587.2021.02.017

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (2): 216-221.DOI: 10.3969/j.issn.1671-2587.2021.02.017

VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析

楚海亮, 邢名泉, 葛洪峰

236800 亳州市人民医院血液内科

收稿日期:2020-07-24 出版日期:2021-04-20 发布日期:2021-04-19
通讯作者: 葛洪峰,男,副主任医师,硕士,主要从事白血病及淋巴瘤研究,（E-mail）ghfzz@163.com。
作者简介:楚海亮（1985-）,男,安徽亳州人,主治医师,本科,主要从事淋巴瘤、骨髓瘤研究,（E-mail）chl10510110364@163.com。

Analysis on Curative Effect of VCD Regimen Combined with Ubenimex on Multiple Myeloma and Factors Influencing Prognosis

CHU Hai-liang, XING Ming-quan, GE Hong-feng

.Department of Hematology, Bozhou People's Hospital, Bozhou 236800

Received:2020-07-24 Online:2021-04-20 Published:2021-04-19

摘要/Abstract

摘要： 目的探讨VCD方案联合乌苯美司治疗多发性骨髓瘤（MM）的临床疗效,并分析预后影响因素。方法回顾性收集我院2015年4月~2019年6月收治的96例MM患者资料,根据治疗方法不同分为VCD组47例、联合组49例,均给予VCD方案（硼替佐米+环磷酰胺+地塞米松）化疗,联合组化疗期间连续服用乌苯美司。3个化疗周期后观察疗效,测定生化指标变化,并统计不良反应及预后情况。结果联合组疾病缓解率为77.55%,明显高于VCD组（P<0.05）。与治疗前相比,两组治疗后骨髓中浆细胞比例、血清M蛋白明显降低,血红蛋白（Hb）显著升高（P<0.05）,但联合组改善效果优于VCD组（P<0.05）。不良反应有便秘、嗜睡、感染性发热、骨髓抑制等,但均以I~II级为主,且两组不良反应发生率均无统计学差异（P>0.05）。2年总体生存（OS）率、无进展生存（PFS）率分别为76.04%、61.46%,单因素分析显示ISS分期、治疗方案、治疗疗效均与OS率、PFS率有关（P<0.05）,COX多因素分析显示ISS分期、治疗方案、治疗疗效均为影响OS率的危险因素（P<0.05）,仅治疗疗效是影响PFS率的危险因素（P<0.05）。结论在VCD方案化疗基础上联合乌苯美司治疗MM可有效提高疗效、改善预后;除治疗方案以外,ISS分期、治疗疗效均为影响预后的独立因素。

关键词: VCD化疗方案, 乌苯美司, 多发性骨髓瘤

Abstract: Objective To explore clinical curative effect of VCD combined with ubenimex on multiple myeloma (MM) and to analyze influencing factors of prognosis. Methods The data of 96 MM patients who were admitted to the hospital from April 2015 to June 2019 were retrospectively collected. According to different treatment methods, they were divided into VCD group (47 cases) and combination group (49 cases). All patients were given VCD (velcade, cyclophosphamide, dexamethasone) regimen for chemotherapy. They were given continuous administration of ubenimex during chemotherapy in combination group. After 3 cycles of chemotherapy, curative effect was observed. The changes in biochemical indexes were measured. Adverse reactions and prognosis were statistically analyzed. Results The disease remission rate in combination group was significantly higher than that in VCD group (77.55% vs 57.45%) (P<0.05). Compared with those before treatment, plasmocyte proportion and serum M protein in bone marrow of both groups were significantly decreased, while hemoglobin (Hb) was significantly increased (P<0.05). The improvement effect in combination group was better than that in VCD group (P<0.05). There were adverse reactions such as constipation, lethargy, infectious fever and bone marrow suppression, all mainly on level Ⅰ-Ⅱ. There was no significant difference in incidence between the two groups (P>0.05). Of the 96 patients, 2-year overall survival (OS) rate and progression-free survival (PFS) rate were 76.04% and 61.46%, respectively. Univariate analysis showed that ISS staging, treatment regimen and curative effect were correlated with OS rate and PFS rate (P<0.05). COX multivariate analysis showed that ISS staging, treatment regimen and curative effect were all risk factors influencing OS rate (P<0.05). Only curative effect was the risk factor influencing PFS rate (P<0.05). Conclusion VCD regimen combined with ubenimex in treatment of MM can effectively improve clinical curative effect, adjust levels of biochemical indexes, and improve prognosis without increasing adverse reactions. In addition to treatment regimen, ISS staging and curative effect are also independent factors influencing prognosis.

Key words: VCD chemotherapy regimen, Ubenimex, Multiple myeloma

中图分类号:

R733.3

楚海亮, 邢名泉, 葛洪峰. VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析[J]. 临床输血与检验, 2021, 23(2): 216-221.

CHU Hai-liang, XING Ming-quan, GE Hong-feng. Analysis on Curative Effect of VCD Regimen Combined with Ubenimex on Multiple Myeloma and Factors Influencing Prognosis[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(2): 216-221.

参考文献

[1] 杨敏. 多发性骨髓瘤患者血清Cys-C、Urea、Scr及β₂-MG水平检测及其临床意义[J].标记免疫分析与临床,2019,26(3):506-510.
[2] PAWLYN C,MORGAN G J.Evolutionary biology of high-risk multiple myeloma[J].Nat Rev Cancer,2017,17(9):543-556.
[3] 黄文阳,邹德慧,刘薇,等.硼替佐米为基础的化疗序贯自体造血干细胞移植治疗伴1q21扩增初治多发性骨髓瘤患者疗效分析[J].中华血液学杂志,2018,39(6):496-500.
[4] YANG H L,ZHENG Y C,ZHANG Y Z,et al.Mesenchymal stem cells derived from multiple myeloma patients protect against chemotherapy through autophagy-dependent activation of NF-κB signaling[J].Leuk Res,2017,60:82-88.
[5] 郑林静,陈蓉艳.乌苯美司联合卡培他滨和洛铂治疗转移性乳腺癌的临床研究[J].现代药物与临床,2019,34(5): 1510-1514.
[6] KYLE R A,RAJKUMAR S V.Criteria for diagnosis,staging,risk stratification and response assessment of multiple myeloma[J].Leukemia,2009,23(1):3-9.
[7] RAJKUMAR S V,DIMOPOULOS M A,PALUMBO A,et al.International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma[J].Lancet Oncol,2014,15(12):e538-e548.
[8] 马荣军,朱尊民,袁晓莉,等.TRACP-5b、PINP及维生素D3在骨髓瘤骨病患者治疗前后的变化及意义[J].中华血液学杂志,2018,39(8):685-687.
[9] 杨毅,韩晨阳,冯联忠,等.来那度胺联合VAD化疗方案治疗多发性骨髓瘤的疗效和安全性[J].中国新药与临床杂志,2017,36(5):292-294.
[10] 韩效林,李敬东,王婉玲,等.沙利度胺联合VAD方案治疗多发性骨髓瘤的疗效及对患者免疫功能的影响[J].癌症进展,2017,15(1):75-78.
[11] TUCHMAN S A,MOORE J O,DECASTRO C D,et al.Phase II study of dose-attenuated bortezomib,cyclophosphamide and dexamethasone (“VCD-Lite”) in very old or otherwise toxicity-vulnerable adults with newly diagnosed multiple myeloma[J].J Geriatr Oncol,2017,8(3): 165-169.
[12] 赖婷,赵茜,李锋,等.不同化疗方案治疗多发性骨髓瘤的成本-效果分析[J].中国实验血液学杂志,2018,26(3): 824-828.
[13] SAKURAYA M,TAMURA J,ITOH K,et al.Aminopeptidase inhibitor ubenimex inhibits the growth of leukaemic cell lines and myeloma cells through its cytotoxicity[J].J Int Med Res,2000,28(5): 214-221.
[14] 何孜岩. 乌苯美司在治疗难治复发性多发性骨髓瘤中的可行性研究[J].中国现代药物应用,2016,10(10):120-121.
[15] 张家友,吴亚兵,刘军慧,等.乌苯美司联合TMP方案治疗多发性骨髓瘤的疗效观察[J].肿瘤药学,2017,7(3):328-331.
[16] HAN L P,ZHANG Y F,LIU S,et al.Autophagy flux inhibition,G2/M cell cycle arrest and apoptosis induction by ubenimex in glioma cell lines[J].Oncotarget,2017,8(64):107730-107743.
[17] BERENSON A,VARDANYAN S,DAVID M,et al.Improved clinical outcomes for multiple myeloma patients treated at a single specialty clinic[J].Ann Hematol,2017,96(3):441-448.
[18] 麦泽锋. 乌苯美司联合紫杉醇与顺铂方案治疗晚期非小细胞肺癌的临床疗效及对免疫功能的影响[J].中国老年学杂志,2016,36(15):3731-3733.
[19] GUO Q,SUI Z G,XU W,et al.Ubenimex suppresses Pim-3 kinase expression by targeting CD13 to reverse MDR in HCC cells[J].Oncotarget,2017,8(42):72652-72665.
[20] 梁赜隐,任汉云,岑溪南,等.硼替佐米为基础的化疗方案治疗多发性骨髓瘤患者的疗效及预后因素分析[J].中华血液学杂志,2014,35(3):225-230.
[21] 年飞鸽,李锋,邵靓婧,等.66例IgG型多发性骨髓瘤患者初诊时IgG水平与疗效及预后的相关性分析[J].中国实验血液学杂志,2019,27(4):1159-1165.

VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析

Analysis on Curative Effect of VCD Regimen Combined with Ubenimex on Multiple Myeloma and Factors Influencing Prognosis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 5

编辑推荐

Metrics

本文评价

关于本刊

作者中心

在线期刊

访问统计

联系我们

[1]	李伟超, 程道胜. CD38单抗治疗多发性骨髓瘤的配血策略[J]. 临床输血与检验, 2020, 22(6): 624-626.
[2]	吕晓华. 异常蛋白凝集干扰交叉配血提示确诊1例多发性骨髓瘤[J]. 临床输血与检验, 2020, 22(4): 443-445.
[3]	聂丽容, 李庆华, 梁亮, 何红华, 马境志. 硼替佐米联合化疗对多发性骨髓瘤的治疗效果及对VEGF、IL-6、IL-17的影响[J]. 临床输血与检验, 2020, 22(2): 211-214.
[4]	冶薇, 程虹, 封敏. 血清DKK1、β2-微球蛋白水平与多发性骨髓瘤患病程度的相关性^*[J]. 临床输血与检验, 2019, 21(6): 564-567.
[5]	曹伟, 王冰莹, 曹颖, 杨勇, 贾延伟, 杜鸿. 多发性骨髓瘤M蛋白Ig类型改变的探讨^*[J]. 临床输血与检验, 2019, 21(1): 65-67.