| Background and objectives:Multiple myeloma(MM) is one of the most common malignancies in immune system. Myeloma cells are derived from B lymphocytes which produce antibodies. Malignant clonal – proliferation of melanoma cells accumulate in the bone marrow and violate the bone marrow and produce large amount of abnormal monoclonal immunoglobulin, causing progressive impairment of immune function and inducing reoccurred infections, pain of bones and anemia. When the immuneglobulin block renal tubular, it can cause renal failure. MM is diversity and it’s still an incurable disease.High dose chemotherapy combined with autologous stem cell transplantation can improve patients’ complete remission(CR) rate, but it’s easy to relapse.Allo-SCT can cure MM in theory.However,because of MM occurs during early age, it’s often complicated by multiple organ dysfunction, and with the high incidence of graft-versus-host disease. That limits allo-SCT in clinical application. Therefore, chemotherapy treatment remains the most important way for MM, but the CR of traditional chemotherapy is low and the remission duration is short.In recent years, with the development of new targeted drugs, treatment of MM has achieved remarkable progress. Bortezomib, the first generation proteasome inhibitor, reversible inhibition of the 26 S proteasome, can block the proteasome- ubiquitin, which makes many kinds of regulatory proteins accumulated intracellular so as to inducing apoptosis of tumor cells. It’s a new kind of anti-cancer drug. Since listing, it’s a perfect choice and a wide range of applications, bringing new light to the treatment of patients with MM. Several studies showed that regimens, which the bortezomib is on the basis, received higher rate of complete remission both in newly diagnosed and relapsed or refractory in MM.We retrospectively analyse efficacy and safety of the treatment of bortezomib in combination with chemotherapy on newly diagnosed patients with MM so as to providing a theoretical basis for clinical treatment.Methods: We retrospectively analysed 35 patients newly diagnosed with MM in our hospital from January 2010 to December 2014,depending on the standards of diagnosis and effects in hematopathy, which is edited by Zhang Zhinan.We classify them according to ISS and sort them depending on the immunoglobulins and the light chain.All the patients were treated with bortezomib-based combination chemotherapy. During the median 3.3 cycles(range: 2 ~ 7) of treatment, 29(82.9%) the effetiveness were assessed according to EBMT. What’s more, the toxicity rating were depending on NCI-CTCAE(the 3.0 version).The median follow-up time was 12.7 months(range:3~49 months),all of the patients done the bone marrow biopsy and serological index test before and after treated with bortezomib-based combination chemotherapy.The ratio of plasma cells and the level of serum immunoglobulin were compared by t test,the remission rate between different group were compared by the X2 test.Results:The total response rate of all the 35 patients is 82.9%.The percentage of plasmacyte were significantly reduced compared with the level at diagnosis(3.53% vs. 42.19%, P<0.01). The immune globulin levels of IgG and IgA decreased from 67.23±34.04g/L and 52.23±25.01g/L to 21.95±15.82g/L and 11.49±15.79g/L, respectively.(P<0.01, vs. the level at diagnosis). Patients in stage I of MM after treatment with joint programme, which the bortezomib is on the basis, have reached at least 77.8% of VGPR and the ORR has reached at 100%, significantly higher than that of patients’ ORR with stage II/III(76.9%). 5 cases of renal insufficiency patients after treatment have significantly improved and the VGPR rate and ORR were at 80%. Then we evaluated the adverse effects according to NCICTCAE 3.0 and found that the common adverse events were hematology toxicity(46%), fatigue(46%), peripheral neuropathy(40%) and infection(29%). Conclusion: In conclusion, Bortezomib-based combination chemotherapy demonstrates high efficacy, favorable tolerability and mild adverse effects in the treatment with newly diagnosed MM. And this therapy programme an significantly reduce the proportion of plasma cells in bone marrow and can induce abnormal immune globulin dropping significantly. Thus, we recommend it for long-term consolidation and maintenance therapy. |
