| BackgroundIn recent years,many clinical studies have found that the efficacy of low-dose thalidomide chemotherapy regimens for the treatment of patients with multiple myeloma(MM)is definite,but there are no uniform standards for the specific doses and courses of treatment used clinically.Related reports indicate that a low-dose thalidomide combination regimen can reduce drug side effects while improving the efficacy of multiple myeloma chemotherapy.The first part of this article is to investigate the efficacy and adverse reactions of low-dose thalidomide combined with chemotherapy in the clinical treatment of patients with multiple myeloma.Transplantation of hematopoietic stem cells to a certain extent can make patients significantly improved,and even have the possibility of cure.It has bee n reported in the literature that thalidomide has a positive effect on induction therapy before transplantation and maintenance therapy after transplantation.However,whether thalidomide can be used as the best maintenance chemotherapy drug after autologo us stem cell transplantation(ASCT)cannot be determined.Therefore,the meta-analysis of the second part of this article aims to elucidate the efficacy and adverse reactions of thalidomide maintenance therapy in patients with MM after ASCT,and to guide clinical medication.Section one: The Clinical efficacy analysis of low-dose thalidomide combined regimen in the treatment of multiple myelomaObjectiveWe retrospectively analyzed the efficacy and adverse reactions of low-dose thalidomide(commodity name: thalidomide)regimen in the treatment of multiple myeloma(MM).MethodsFrom January 2010 to December 2017,131 patients with MM were treated with thalidomide in the First Affiliated Hospital of Nanchang University,and 30 patients with MM were treated with a low-dose thalidomide combination protocol standardized for 2 to 4 cycles.Of these patients,24 were untreated,6 were relapsed/refractory,and chemotherapy regimens included(PAD-T,TAD,BDT,VAD-T,DVD-T,TCD,and BCD-T);patients were assessed to include low-dose thalidomide.The efficacy and adverse reactions of the amine(50mg/d to 200mg/d)chemotherapy regimen,serum albumin,serum immunoglobulin,and bone marrow were evaluated before and after the second chemotherapy cycle and after the fourth chemotherapy cycle.Plasma cell number,serum creatinine,hemoglobin,blood calcium,etc.Using SPSS17.0 software,t-test and X2 test were used for statistical analysis of measurement data and count data.ResultsIn 30 patients with MM,the total effective rate was 83.3%.The total effective rate of the initial treatment group was 87.5% in the 30 patients after 2 courses of chemotherapy,and 66.7% in the relapsed/refractory group.There was no significant difference in the total effective rate between the two groups(P>0.05).The total effective rate of the 30 patients after 2 courses of chemotherapy was 73.3%,and the total effective rate of the 22 patients after 4 courses of chemotherapy was 90.1%.There was no significant difference in the total effective rate between the two groups(P>0.05).The total effective rate of 15 cases of thalidomide 50 mg/d to 100 mg/d group was 86.7%,and the total effective rate of 15 cases of thalidomide 125 mg/d to 200 mg/d group was 80.0%.There was no statistical difference i n total effective rate between the two groups.Significance(P>0.05);After 2 courses of chemotherapy in the two groups,the total effective rate was 50 mg/d to 100 mg/d,73.3%,and the total effective rate was 125mg/d to 200 mg/d,80.0%.The difference was not statistically significant(P>0.05);after 4 courses of chemotherapy in both groups,the total effective rate was 50.0% in the 50 mg/d to 100 mg/d group,and 90.9% in the 125 mg/d to 200 mg/d group.There was no significant difference between the two groups(P>0.05).The total effective rates of 11 cases of PAD-T,5 cases of BDT,and 5 cases of TAD were 81.8%,100%,and 60.0%.There was no significant difference in the total effective rate among the three groups after chemotherapy(P>0.05).The total effective rate of 11 cases of PAD-T,5 cases of BDT and 5 cases of TAD after 2 courses were 63.6%,100% and 60%.There was no significant difference in the total effective rate among the three groups after chemotherapy(P>0.05);After 4 courses of treatment,the total effective rates of 5 cases of PAD-T,3 cases of BDT,and 4 cases of TAD were 100%,100%,and 75%.The difference in total effective rate among the three groups after chemotherapy was not significant.Statistical significance(P>0.05);The total effective rates of 7 cases of PAD-T,5 cases of BDT,and 4 cases of TAD were 71.4%,60%,and 100%.There was always a difference between the three groups after chemotherapy.There was no significant difference in efficiency(P>0.05).The median hemoglobin counts before and after chemotherapy in 30 patients were 85.00±24.39 g/L and 111.61±17.46 g/L(P<0.05);the median albumin levels before and after chemotherapy were 34.80±6.87g/L and 38.18±4.93/L,which was statistically significant(P<0.05);the median percentage of bone marrow plasma cells before and after chemotherapy was 26.67±22.27% and 3.71±7.45%,which was statistically significant(P<0.05);The median IgG levels before and after IgG chemotherapy in 13 patients were 58.0±30.89 g/L and 17.49±15.38 g/L,which was statistically significant(P<0.05).The median IgA before and after chemotherapy in 9 cases of IgA was 37.86±24.75g/L and 9.43±13.43g/L,which was statistically significant(P<0.05).The median blood calcium before and after chemotherapy was 2.32±0.25 mmol/L and 2.23±0.20 mmol/L,which was not statistically significant(P>0.05).The main adverse reactions in all patients were: peripheral neuropathy in 2 cases,lower extremity edema in 2 cases,drowsiness in 1 case,dizziness in 4 cases,fatigue in 2 cases,and constipation in 6 cases.The incidence of adverse reactions was 56.7%.Conclusion(1)The combined treatment with low-dose thalidomide(50 mg/d to 200 mg/d)combined regimen had a high total response rate and fewer adverse reactions;(2)low-dose thalidomide 50 mg/d to 100 mg/d and 125 mg/d to 200mg/d has similar efficacy in treating MM;(3)The percentage of bone marrow plasma cells and immunoglobulin after treatment with MM containing low dose of thalidomide are significantly decreased,and hemoglobin and serum albumin are significantly improved.Section two: the meta-analysis of thalidomide maintenance therapy for multiple myeloma after autologous stem cell transplantationAim: the study aim to compare thalidomide maintenance with other regimens after autologous stem cell transplantation for multiple myeloma.Material and method: Databases were searched to evaluate the impact of thalidomide.pubmed,cochrane and embase were searched for randomized controlled trials.Main outcome measures were overall survival(OS)and progression-free survival(PFS),adverse events.Results: eight trials were included(N=3412),thalidomide dose and treatment regimens differed between trials.Patients treated with thalidomide maintenance had better overall survival(hazard ratio HR 0.86,p=0.011),particularly combined with corticosteroids(HR 0.73,p=0.001).Thalidomide improved progression-free survival(hazard ratio HR 0.65,p<0.01),but had more frequent venous thrombosis(RR 1.94,95%CI=1.33-2.82)and peripheral neuropathy(RR 3.85,95%CI=1.82-8.14).Conclusion: thalidomide is an effective treatment for MM patients after ASCT.However,treatment-related adverse events must be considered and appropriate adjustments. |
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