| Background Multiple myeloma(MM)is a second-position blood system tumor that occurs in middle and old people with a incidence of 1% of all human tumors and 10% of hematological malignancies.In the past ten years,the treatment plan of MM has been continuously optimized,and the curative effect has been significantly improved.Treatment for younger patients includes induction therapy for new drugs,autologous transplants and consolidation and maintenance of new drugs.This treatment strategy results in a 5 year survival rate of 80% and allows some patients with good prognostic factors to achieve longer survival.However,the curative effect for elderly patients over 65 years old is slower.The number of MM patients will increase significantly in the future due to the prolonged life expectancy and the emergence of new anti myelomadrugs.In recent years,with the application of bortezomizomib,thalidomide,the efficacy of MM is obviously improved,and the patient's disease free survival(PFS)and the total survival time(OS)are prolonged.However,there are still some MM patients who experience multiple relapses and drug resistance during the course of disease.The treatment of such patients is an unavoidable challenge we must face.Lenalidomide is a derivative of thalidomide.Studies have shown that the drug has a stronger anti-tumor effect and has no teratogenic effect of thalidomide,and the drug has less adverse reactions.The proliferation activity of T cells was 50-200 times that of thalidomide,and the inhibitory effect of TNF-? increased significantly,while the stimulation of IL-2 secretion was 50-100 times stronger than thalidomide,and the effect of DNA synthesis in myeloma cells in vitro was stronger than that of thalidomide.In preclinical studies,lenalidomide can induce apoptosis of MM cell line and primary MM cell in G1 phase through casepase 8.Compared with thalidomide,lenalidomide can overcome the resistance of MM cells and enhance the anti MM effect of dexamethasone.All these results indicate that lenalidomide is effective in the treatment of drug-resistant MM.Objective To investigate the efficiency and safety of lenalidomide combined with dexamethasone in the treatment of relapsed or refractory multiple myeloma(MM)patients and analyze the curative effect of different stages of patients.Methods 21 patients with replased or refractory MM were collected from the Department of Hematology,affiliated to the cancer hospital,Zhengzhou University,from May 2017 – July 2017,who were treated with lenalidomide and dexamethasone(Rd).Specific treatment scheme: lenalidomide: 25mg/d,continuous oral for 21 days,rest for 7 days;dexamethasone 40mg/w for 4 weeks.During the treatment period,blood routine,blood biochemistry,electrolytes and urine routine were monitored,and the dosage of drugs were adjusted according to the renal function and blood routine.Bone marrow aspiration and biopsy were reviewed regularly.Adverse reactions were observedduring the medication and symptomatic treatment was given in time.To evaluate the efficacy and side effects of the combination of lenalidomide and dexamethasone by evaluating the efficacy and adverse reactions of the patients.According to the patient's age/sex/subtype,the curative effect of different age / sex / subtype patients was analyzed.According to the relapse / refractory condition,the patients were divided into relapsed and refractory groups,and the curative effect of recurrent / refractory patients was compared.According to whether the patients had extramedullary infiltration / renal insufficiency / diabetes,they were divided into extramedullary infiltration group / uncombined extramedullary infiltration group,renal insufficiency group / renal function group,diabetes group / no diabetic group,and analyzed the effect of the patients in each group.The effectiveness of the patients in each group was analyzed in the group / uncombined extramedullary infiltration group,renal insufficiency group / normal renal function group,diabetic group / non diabetic group,and analyzed the effect of the patients in each group.According to the previous treatment of thalidomide / bortezomib / hematopoietic stem cell transplantation,the patients were divided into thalidomide exposure group / thalidomide unexposed group,bortezomizomi exposure group / bortezomizomi unexposed group,transplant group / untransplanted group,and analyzed the efficacy of the patients in each group.Results 1.The total response rate(ORR)was 61.9%(13/21)in 21 cases of relapsed and refractory MM treated with Rd,of which 11(52.4%)received partial response(PR).Common adverse reactions include myelosuppression,gastrointestinal reactions and infections,which can be tolerated after timely treatment of the symptomatic.2.The curative effect analysis of different age / sex / typing patients showed that the older / female / heavy chain patients had poor curative effect,and the difference was not statistically significant.3.The ORR of relapsed group and refractory group was 75% VS 20%,respectively,and the difference was statistically significant(P=0.047).The ORR of extramedullaryinfiltration group and non extramedullary infiltration group was 100% VS 46.7%,respectively,and the difference was statistically significant(P=0.046).4.The ORR of the renal insufficiency group and the normal renal function group were 71.4% VS 57.2%,respectively,and the difference was not statistically significant(P=0.656).The ORR of DM group/non DM group was 66.7% VS 61.1%,the difference was not statistically significant(P=1.0).5.The ORR of thalidomide exposed group / unexposed thalidomide group was 60% VS 66.7%,the difference was not statistically significant(P=1.0).The ORR of the bortezomib unexposed group and bortezomib exposed group was 80% VS 45.5%,the difference was not statistically significant(P=0.183).The ORR of the transplant group and the non transplant group were 80% VS 56.3%,respectively,and the difference was not statistically significant(P=0.606).Conclusions 1.Lenalidomide combined with dexamethasone is effective in treating relapsed and refractory MM,with mild adverse reactions.2.Lenalidomide combined with dexamethasone has a significant effect on relapsed MM patients.The curative effect is better for relapsed and refractory MM patients with extramedullary infiltration.3.Lenalidomide combined with dexamethasone is still effective for relapsed and refractory MM patients with renal insufficiency / diabetes.4.Relapsed and refractory MM patients who have previously received thalidomide/bortezomib can also benefit from the treatment of combined lenalidomide with dexamethasone.Patients who had received hematopoietic stem cell transplantation were also able to benefit. |
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