| ForewordMultiple myeloma(multiple myeloma, MM) is a monoclonal bone marrow plasma cells and secrete abnormal proliferation of M protein, resulting in hematopoietic malignancies related organ or tissue damage, accounting for 1% of all malignant tumors, accounting for hematopoietic malignancies 10%. With advances in diagnostic techniques and aging population, the incidence of the disease gradually increasing trend in recent years. The disease occurs in the elderly, with a median age of onset is about 65 years old, male to female ratio of about 3: 2, every year about 14,000 new patients diagnosed with MM's. The exact mechanism for MM pathogenesis is not clear, it is a malignant proliferative disease, originated after the germinal center B cells and is capable of producing a monoclonal immunoglobulin. With the development of a variety of molecular biology, immunology and genetics technology, awareness of its pathogenesis gradually deepening. Multiple myeloma because older patients, complete remission rate, easy to resistance, and high recurrence rate characteristics of poor clinical outcome. Treatment, high-dose chemotherapy with autologous stem cell transplantation, although able to increase the rate of complete remission, but easy to relapse, not cure multiple myeloma fundamentally. Allogeneic hematopoietic stem cell transplantation may heal multiple myeloma in theory, but for older patients, often important viscera function is not complete and transplant related mortality rate higher factor limiting its clinical application. The aim of treatment for most patients with multiple myeloma is to lengthen life, improve the quality of life.Chemotherapy is still the most basic, the most commonly used method, can obviously prolong the lifetime. Now MM treatment with combination chemotherapy is given priority to, still in recent years, with the new drug boron for rice, the application of the new drugs such as degree of gilad amine, obviously improve the response rate in patients with MM, obviously prolong survival time. In recent years, with the new drug proteasome inhibitor bortezomib, immunomodulators thalidomide, lenalidomide new drug application amine, MM remission rate was significantly improved survival time significantly extended, but MM is a complex physical illness, in genetic abnormalities, treatment response and toxicity incidence of great heterogeneity, resulting in individual differences in overall response and survival of patients who received the same chemotherapy, due to age, stage, genetic abnormalities and renal function is different, treatment response and overall survival have some differences. Commonly used in clinical boron bortezomib combination chemotherapy BADT, the lack of a comparison between the mutual BCD, clinical efficacy and adverse reaction rate between BD, age, ISS stage, less renal function, genetic abnormalities affect the efficacy of the report. The present study retrospectively analyzed 69 patients with previously untreated MM patients, analysis efficacy and adverse reactions to the initial treatment of choice for MM treatment programs provide references.Objective 1 Discussion of boron for three different chemotherapy regimens of zolmitriptan(BADT, BCD, BD) clinical efficacy and side effects of newly diagnosed MM, provide the basis for the initial treatment of chemotherapy in patients with MM selection. 2 Discussion of age, ISS staging of renal function on the bortezomib three different chemotherapy regimens in newly diagnosed MM for MM patients to further optimize treatment choices.Methods 1 Retrospective analysis of newly diagnosed multiple myeloma patients, the Second Affiliated Hospital of Zhengzhou University, Henan Provincial People's Hospital Department of Oncology and Hematology from January 2010 to June 2015 were treated 69 cases, according to different treatment options are divided into groups BADT(bortezomib + doxorubicin + dexamethasone + thalidomide), BCD group(cyclophosphamide + bortezomib + dexamethasone) and BD group(boron bortezomib + dexamethasone). 2 Record diagnosed gender, age, blood, C- reactive protein, the first symptom, chromosomes, FISH, lactate dehydrogenase, serum protein electrophoresis, M protein, IFE, the proportion of plasma cells in the bone marrow, blood(urine) light chain levels, whole body bone ECT, ?2-microglobulin, calcium, blood urea nitrogen, creatinine, albumin and other related indicators. During treatment to detect and record changes in the index. 3 According to the International Myeloma Working Group(IMWG) efficacy criteria for the three groups of multiple myeloma treatment effect analysis and evaluation, and statistical analysis. 4 Data were SPSS 17.0 software for statistical analysis, treatment efficiency and the incidence of adverse reactions in comparison preclude the use of ?2 test and Fisher's exact test, P <0.05 was considered statistically significant.Results 1 BADT group and BCD group than in BD group showed a better response rate and efficiency, efficiency of 86.9%, respectively, 73.3 and 54.8% response rate was 34.7%, 33.3% and 9.6% respectively, the difference was statistically significance. 2 Age grouping BADT, BCD, ORR difference BD three treatment program young patients was not statistically significant, the elderly group ORR was 81.3%, 50.0%, 36.9%, the difference was statistically significant. 3 ISS stage of MM patients packet of ISS I BADT, BCD, twenty-two comparing ORR and CR rates were not statistically different BD treatment. BADT group II patients with BD group ORR rate statistically significant(P = 0.036), but no significant difference in CR rate, BADT group ? patients with no significant difference between BCD group CR rate and ORR rates, but BADT group and BCD group and BD group CR rate, ORR rate were statistically significant. 4 Renal function packet regardless creatinine greater than 2mg / dl or creatinine subgroup of less than 2mg / dl subgroup BADT and BCD CR group were higher than the BD group, the creatinine greater than 2mg / dl group and subgroup BADT BD group, BCD group compared with the BD group CR rate, P values were 0.034,0.015, with statistical significance; creatinine less than 2mg / dl subgroup BADT group compared with the BD group, BCD group with BD group CR rate, P values were is 0.025,0.016, with statistical significance. 5 In the FISH group, we will be divided into MM FISH was no significant difference in normal and abnormal ORR rate of normal and abnormal FISH group, BADT group, BCD Group, BD three groups. 6 Adverse reactions BADT treatment group and treatment group BCD hematological toxicity rates were 56.5%, 53.5%, 16.1% higher than BD treatment group. BADT group had peripheral neuropathy accounted for 60,8% and 46.6% higher than the BCD group BD group 35.4%, BCD Group and BD group infection rates were 15.0%, 16.1%, 39.1% lower than BADT group. Overall BADT group, BCD adverse reactions higher rate than BD group.Conclusions 1 BADT BCD program and treatment of multiple myeloma and efficient overall response rate than BD program. 2 BADT group, BCD Group in elderly MM group ORR was higher than BD group, no difference in the youth group; ISS staging of ISS I BADT MM patients, BCD, BD regimen CR rate and ORR rate was no significant difference, II patients BADT group ORR was higher than BD group, but no significant difference in CR rate, BADT group ? patients with no significant difference between BCD group CR rate and ORR rate, but BADT group, BCD group CR rate, ORR was higher than BD group; renal function packet BADT group, BCD group CR rate in BD group. 3 FISH normal and abnormal group BADT group, BCD Group and BD group ORR was no significant difference due to small sample size, statistical analysis needs further large multi-center sample FISH packet. 4 Adverse reactions BADT treatment group and treatment group BCD hematological toxicity ratio higher than BD treatment group; peripheral neuropathy BADT group was higher than BCD and BD group; BCD Group and BD group infection rate lower than BADT group; overall BADT group, BCD adverse reactions higher rate than BD group. |
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