A Clinical Study Of107Cases With Plasma Cell Disorders

【Objective】To summary the incidence and treatment of various plasma celldisorders(PCL) in the past five years in our hospital.【Methods】From July2009to March2014, total of107cases with PCL wereenrolled in our study in the Second Affiliated Hospital of Soochow University, including89cases with Multiple Myeloma(MM),3cases with Plasma Cell Luekemia(PCL),11cases with Waldenstroms Macroglobulinemia(WM) and4cases with Solitary/MultiplePlasmacytoma. Diagnostic criteria and efficacy assessments were referring to a unifieddiagnostic criteria of the International Myeloma Working Group(IMWG) to develop.【Results】(1) In MM patients,57patients are available for evaluation. Thirty-eight cases withbortezomib-based regimen with overall response rate (ie, patients received at least partialremission) was94.7%; seven cases with MP (melphalan+prednisone) to treat, the overallresponse rate was42.9%; twelve cases with VAD (vincristine, doxorubicin anddexamethasone) in patients treated based program, the overall response rate was66.7%.Bortezomib regimen was significantly superior to MP and VAD regimen and there weredifference between them. But no significant difference can be seen in the groups of MPand VAD.In Durie-Salmon (DS) staging Ⅰ/Ⅱ stage patients,7cases used bortezomib-basedregimen with efficiency of100%; one case in MP regimen, the effective rate is0; VADgroup was no similar patients. In stage Ⅲ patients,31cases with bortezomib regimen, theefficiency was93.5%; six cases with MP regimen, the efficiency was50%; twelve caseswith VAD regimen, the efficiency was66.7%. Bortezomib group were significantly betterthan the other two groups, a significant difference. There are no significant differencebetween stageⅠ/Ⅱ and Ⅲ with same treatment regimen.In Inernational Stage System (ISS) stages Ⅰ/Ⅱ stage patients,23cases used bortezomib regimen with the effective rate of91.3%; three cases in MP regimen, theeffective rate was66.7%; seven cases with VAD regimen, the effective rate was57.1%, nosignificant difference among the three groups. In Ⅲ period,15patients with bortezomibtreatment, the efficiency was100%;4cases with MP regimen, the efficiency was25.0%;4cases with VAD regimen, the efficiency was75.0%. bortezomib and MP group havestatistically significant. There are no significant difference between stageⅠ/Ⅱ and Ⅲwith same treatment regimen.A group of kidney function in patients with bortezomib group of25patients, MP inthe treatment of4cases,11cases of VAD group, the efficiency was respectively96.0%,25.0%,63.6%. Bortezomib group was superior to the other two groups. Renal patients ingroup B, bortezomib group of13patients, MP with3patients, VAD with1patients, afterappropriate treatment program, efficiency was92.3%and66.7%,100%, respectively.Among the three groups had no significant statistical differences. There are no significantdifference between group A and B with same treatment regimen.No bone pain symptoms in patients treated with bortezomib with15cases, theefficiency was100%; MP group of five cases, the efficiency was40.0%; VAD group offour cases, the efficiency was50.0%. Bortezomib group was superior to the other twogroups. There are symptoms of bone pain in patients with bortezomib group of23cases,with efficiency of91.3%; MP group with2cases, efficiency was50.0%; VAD group with8cases, the effective rate was75.0%. No significant difference between the three groups.There are no significant difference between without pain and bone pain with sametreatment regimen.(2)Three cases of PCL patients were treated with bortezomib at least one course ofchemotherapy. One case before the second courses of treatment was considered diseaseprogression (PD); one case was considered stable disease (SD) after one course; the thirdcase was considered complete remission (CR) after one course, but in the second course oftreatment, died due to severe arrhythmia. Results are all not good.(3)Seven cases of WM patients, one case with FCD regimen (fludarabine,cyclophosphamide, and dexamethasone) for4cycles was considered CR;2cases withCOP (cyclophosphamide, vincristine, and dexamethasone), after an average of four cyclesof chemotherapy, were considered both SD;2cases with Rituximab treatment, completedat least five courses of chemotherapy, one case was CR, the other partial remission (PR); the last2cases with bortezomib regimen, accepting two courses of treatment, one case wasCR, the other PR.(4) Four cases of patients with plasmacytoma used surgery plus radiotherapy orsurgery+radiotherapy+chemotherapy treatment, showed significant improvement whencompared to the onset of symptoms.【Conclusions】1, With the aging of the population, the incidence of plasma cell disorders, especiallymultiple myeloma, is increasing every year.2, For MM patients with bortezomib-based regimen is superior to MP andVAD-based chemotherapy in overall response rate.3, According to disease stage, renal function, with or without bone pain, groupedapplication bortezomib significantly better than conventional chemotherapy, or efficacyclose to the MP group and VAD group (considering the sample size is too small). With thesame treatment regimen, there are no significant difference bentween disease stage, renalfunction and with or without bone pain.4, PCL with poor prognosis, bortezomib therapy can improve patient treatmentefficiency.5, WM is currently no specific treatment, the application of Rituximab or bortezomibtreatment is expected to improve the therapeutic effect.6, Depending on the type of plasmacytoma, treatment can be taken to surgery plusradiotherapy, surgery+radiotherapy+chemotherapy. Application bortezomibchemotherapy may improve the outcome.