A Clinical Study Of Bortezomib In Combination With Dexamethasone In Multiple Myeloma

【Objective】To investigate the clinical response and side effects of bortezomib anddexamethasone(VD) based regimen in patients with multiple myeloma(MM).【Methods】From July2009to Dec2012, total of28patients with MM were enrolledin our study in the Second Affiliated Hospital of Soochow University. The basictreantment regimen for those patients were bortezomib and demamethasone(VD) and thecombination therapy including thalidomide,doxorubicin, melphalan, or cyclophosphamide.All patients met the domestic diagnostic criteria proposed by Dr. Zhang zhi nan ect.According to immune electrophoresis, the MM patients were divided into five subtypes:IgG, IgA, IgD, IgM and IgE. In the meantime theywere also divided into kappa or lambdachain positive MM according to the monoclonal immunoglobulin light chain detected inthe serum or urine. For those who had no M protein secretion in the sera or urine callednon-secretory MM. Durie-Salmon stage system and International staging system were usedto stage Ⅰ,Ⅱ and Ⅲ.Serum creatinine＜176.8umol/L was A group, serum creatinine≥176.8umol/L was B group. IMWG Standard was used to evaluate the efficacy andNCI-CTCAE3.0was used to decide the adverse effect.All patients received at least onecycle of chemotherapy in this program． At the same time received adjuvanttherapy．Efficacy and adverse reactions were observed between untreated group andrelapsed or refractory group, group A and B,the light chain and non-light chain, IgG andIgA type.【Results】24patients were evaluated the efficacy(The efficency was evaluated afterthe patients received1,2,4cycle),and completed three cycles of treatment. The overallresponse rate is79.17%,and the rate ofCR,VGPR,PR reached31.58%,52.63%,15.79%respectively.The newly diagnosed patients have higher response rate thanrelapsed,refractory multiple myeloma(94.12%vs42.86%， p=0.014).There were no differency between the group of A and B,light chain and heavy chain subtypes,IgA andIgG subtypes. With the increase of the number of cycles, the efficiency gradually increasedfrom1to4cycles.8patients with renal failure completed2.5cycles in24persons.The number ofCR,VGPR,PR is2,2,1,and the ORR is62.5%.ORR with and without renal failure was notdifferent(p=0.1747).But reversibility of renal failure reached37.5%.The main adverse effects were fatigue(57.14%),infection(42.86%),thrombocytopenia(42.86%),neutropen-ia(39.29%),peripheral neuro-pathy(35.71%), constipation(25%),diarrhea(14.29%),vomiting(7.14%),elevated transaminase(10.71%).Most of the adverseeffects were mild to moderate and could be relieved by symptomatic treatments. Notreatment-related mortality occured.【Conclusions】The chemotherapy of using bortezomib combined dexamethasone formultiple myeloma has a high complete remission rate and overall response rate and theside effects are mild. The newly diagnosed patients have higher response rate than relapsed,refractory multiple myeloma.The dose of bortezomib need not to be adjusted in patientswith renal failure,.This chemotherapy reverses renal dysfunction. Treatment-relatedperipheral neuropathy can be controlled and tolerated. The efficiency gradually increasedin4cycles.