| Objectives : This retrospective study is to assess the efficacy of bortezomib in the treatment of multiple myeloma(MM)patients.To compare the differences in efficacy and side effect of treatment with or without bortezomib as well as the differences between methods of administration.Methods:A total of 90 MM patients from 2005 to 2015 were analyzed retrospectively,including 51 males and 39 females.The median age was 61(49-70)years old.According to whether the disease was newly diagnosed or relapsed,there were newly diagnosed active MM(50 cases),relapsed refractory MM(40 cases);according to different chemotherapeutic regimens,52 cases were treated with bortezomib(chemotherapy regimens PAD PCD PTD),38 cases without bortezomib.(chemotherapy regimens VAD VCD VTD);Patients received standard chemotherapy for 2-4 courses;factors such as the high-risk FISH relevance ratio,cases of kidney damage,chemotherapeutic regimens,the efficacy after 2 or 4 courses and Karyotype evolution,corresponding side effects at the onset of the disease were collected.To assess: 1.The efficacy difference of bortezomib and non-bortezomib group(2 and 4 cycles),The efficacy difference bortezomib group(PAD PCD PTD)in Multiple myeloma patients;2.The difference of bortezomib and non-bortezomib group in peripheral nerve toxicity,hematological system effect,post-chemotherapy infection and digestive system reaction;3.The recovery of high-risk FISH relevance ratio and kidney damage in newly diagnosed and relapsed Multiple myeloma patients;4.The different of curative effect and peripheral nerve toxicity of bortezomib in subcutaneous and intravenous injection.Results:Among the 90 cases of patients,50 cases were newly diagnosed active MM patients and 40 cases were relapsed refractory MM patients.1.In terms of chemotherapy effect:(1)Relationship between chemotherapy regimens and chemotherapy effect.(1)For the newly diagnosed active MM patients: the overall remission rate(ORR)after 2 courses and 4 courses in patients treated with bortezomib(30 cases)were: 73.3%and 80%(P<0.05).ORR after 2 courses and 4 courses in patients treated without bortezomib(20 cases)were: 45% and 52.6%(P<0.05).(2)For the relapsed refractory MM group: ORR after 2 courses and 4 courses in patients treated with bortezomib(22 cases)were: 59.1% and 66.7%(P<0.05).ORR after2 courses and 4 courses in patients treated without bortezomib(18 cases)were: 27.8%and 35.3%(P<0.05).(3)For the patients treated with bortezomib,ORR after 2 courses of PAD,PCD and PTD regimen in newly diagnosed active MM group(30 cases)was 75%,71.4%,75%(P>0.05).ORR after 2 courses of PAD,PCD and PTD regimen in relapsed refractory MM group(22 cases)50%,60%,66.7%(P>0.05),respectively.ORR after 4 courses of PAD,PCD and PTD regimen in newly diagnosed active MM group(30 cases)was 75%,78.6%,87.5%(P>0.05),respectively.ORR after 4 courses of PAD,PCD and PTD regimen in relapsed refractory MM group(22 cases)was 66.7%,66.7%,66.7%(P>0.05),respectively.(2)Relationship between modes of administration and chemotherapy effect.(1)For the 30 cases of newly diagnosed active MM patients treated with bortezomib,13 cases received subcutaneous injection and 17 cases received intravenous injection.After 2 courses and 4 courses,ORR of patients received subcutaneous injection were76.9% and 70.6%(P>0.05),and ORR of patients received intravenous injection were84.6% and 76.4%(P>0.05).(2)For the 22 cases of relapsed refractory MM patients treated with bortezomib,14 cases received subcutaneous injection and 8 cases received intravenous injection.After 2courses and 4 courses,ORR of patients received subcutaneous injection were 64.3% and50%(P>0.05),and ORR of patients received intravenous injection were 76.9% and72%(P >0.05).(3)For all the 52 cases treated with bortezomib,27 cases received subcutaneous injection and 25 cases received intravenous injection.After 2 courses and 4 courses,ORR of patients received subcutaneous injection were 70.4% and 64%(P >0.05),and ORR of patients received intravenous injection were 76.9% and 72%(P >0.05).(3)High risk FISH was detected.Among the 39 cases of newly diagnosed active MM patients,abnormality was detected in 15 cases with 3 high risk FISH.Among the 33 cases of relapsed refractory MM patients,abnormality was detected in 18 cases with 11 high risk FISH.Comparison of high risk FISH detection rate between the 2 groups(P<0.05).(4)Improvement of renal function: Among the 90 cases of patients,35 cases have renal dysfunction,21 cases in bortezomib group and 14 cases in non-bortezomib group;After 2 courses,ORR in the two goups was 81.0% and 42.9%,respectively(P<0.05).2.In terms of side effects of chemotherapy: Most of the side effects in the bortezomib group was level I or ?,a few patients have level ? side effect,mostly myelosuppression(mainly thrombocytopenia)and peripheral neuropathy.While most of the side effects in the non-bortezomib group was level I to ?,a few patients have level? side effect,mostly myelosuppression(mainly granulopenia,anemia and thrombocytopenia).(1)Incidence rate of peripheral neuropathy in 27 cases with received subcutaneous injection was 22.2%,and 25 cases with peripheral neuropathy received intravenous injection was 52%(P <0.05);(2)Incidence rate of hematologic side effects in 52 cases of bortezomib group and non-bortezomib group was 23.1% and 44.7%(P<0.05).(3)Incidence rate of infection after chemotherapy in 52 cases of bortezomib group and non-bortezomib group was 30.8% and 52.6%(P<0.05).(4)Incidence rate of digestive system side effects in 52 cases of bortezomib group and non-bortezomib group was 32.7% and 34.2%(P<0.05).Conclusions1.The chemotherapy with bortezomib has significant efficacy in newly diagnosed active MM and relapsed refractory MM,and the incidence of side effect is low.2.There are no significant difference between PAD?PCD?PTD treatment.3.There are more neurotoxicity and less hematologic adverse reactions,incidence of infection in bortezomib group.There are no significant difference in astrointestinal adverse.4.There are no significant different efficacy between hypodermic injection and intravenous injection,but the peripheral neurotoxicity of hypodermic injection is lighter than intravenous injection.5.The renal response rate in bortezomib group is better.6.There are more positive incidence of high dangerous mark through FISH check in relapsed refractory MM than newly diagnosed active MM. |
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