切换至 "中华医学电子期刊资源库"

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (01) : 20 -22. doi: 10.3877/cma.j.issn.2096-0263.2018.01.005

所属专题: 文献

骨肿瘤

来那度胺联合小剂量地塞米松治疗老年多发性骨髓瘤患者的安全性观察
汤然1, 钟玉萍1,(), 张佳佳1, 李新1, 安娜1, 申曼1   
  1. 1. 100043 首都医科大学附属北京朝阳医院西院血液科
  • 收稿日期:2017-07-21 出版日期:2018-02-05
  • 通信作者: 钟玉萍
  • 基金资助:
    北京市自然科学基金自助项目(7162067)

Treatment with lenalidomide and dexamethasone for elderly multiple myeloma

Ran Tang1, Yuping Zhong1,(), Jiajia Zhang1, Xin Li1, Na An1, Man Shen1   

  1. 1. Department of Haematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
  • Received:2017-07-21 Published:2018-02-05
  • Corresponding author: Yuping Zhong
  • About author:
    Corresponding author: Zhong Yuping, Email:
引用本文:

汤然, 钟玉萍, 张佳佳, 李新, 安娜, 申曼. 来那度胺联合小剂量地塞米松治疗老年多发性骨髓瘤患者的安全性观察[J/OL]. 中华老年骨科与康复电子杂志, 2018, 04(01): 20-22.

Ran Tang, Yuping Zhong, Jiajia Zhang, Xin Li, Na An, Man Shen. Treatment with lenalidomide and dexamethasone for elderly multiple myeloma[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(01): 20-22.

目的

观察来那度胺联合小剂量地塞米松(Rd)治疗老年多发性骨髓瘤的疗效及安全性。

方法

回顾性收集2013年6月至2017年6月首都医科大学附属北京朝阳医院西院血液科收治的老年骨髓瘤患者共36例,其中男性23例(63.9%),女性13例(36.1%),年龄(72.0±2.4)岁,均给予Rd方案治疗,具体为:来那度胺25 mg/qod或者10 mg/qd,d1~21,地塞米松10~20 mg/w,28 d为1个疗程。采用国际骨髓瘤工作组(IMWG)标准评价治疗效果,按照国际肿瘤组织毒副作用统一命名法的标准(NCICTCAE第3版)判断不良反应。

结果

36例患者获得满意随访,随访率100%,随访时间1~48个月,平均(20±3)个月。末次随访时,1例(2.7%)达到完全缓解,10例(27.8%)非常好的部分缓解,13例(36.1%)部分缓解,6例(16.7%)疾病稳定,4例(11.1%)疾病进展,2例(5.6%)死亡,总有效率为66.6%。不良反应主要为乏力及骨髓抑制。

结论

来那度胺联合小剂量地塞米松治疗老年多发性骨髓瘤患者,疗效好,患者耐受性好,可作为老年多发性骨髓瘤患者的推荐治疗方案。

Objective

To evaluate the efficacy and safety of lenalidomide plus low-dose dexamethasone in the treatment of elderly multiple myeloma (MM) patients.

Methods

The clinical records of 36 elderly MM patients were analyzed including 23 males (63.9%) and 13 females (36.1%). The average age was 72.0±2.4 years and all patients were treated with lenalidomide plus low-dose dexamethasone (lenalidomide 25 mg/qod or 10 mg/qd on day 1-21 of each 28-day cycle, dexamethasone 10-20 mg per week). Adverse reaction and therapeutic efficacy was determined by NCICTCAE (3rd edition) and IMWG.

Results

There were 36 patients well followed-up with an average of 20±3 months, range of 1-48 months, the complete ratio of follow-up was 100%, 1 patient (2.7%) achieved complete response (CR), 10 cases (27.8%) were very good partial response (VGPR), 13 cases (36.1%) were partial response (PR), 6 cases (16.7%) were stable disease (SD), 4 cases (11.1%) were progressive and 2 died (5.6%). The overall response rate (ORR=CR+VGPR+PR) was 24/36 (66.6%). The most common adverse was fatigue and dexamyelosuppression.

Conclusion

Lenalidomide plus low-dose dexamethasone is a safe and effective treatment for elderly MM patients. This combined treatment is recommended to elderly MM patients.

表1 36例老年骨髓瘤患者的疾病特征
1
Sharpe AH, Abbas AK. T-cell costimulation--biology, therapeutic potential, and challenges [J]. N Engl J Med, 2006, 355(10): 973-975.
2
Hayashi T, Hideshima T, Akiyama M, et al. Molecular mechanisms whereby immunomodulatory drugs activate natural killer cells: clinical application [J]. Br J Haematol, 2005, 128(2): 192-203.
3
Bartlett JB. Lenalidomide enhances tumor killing invitro during ADCC mediated by Trastuzumab, Cetuximab, and Rituximab [J]. J Clin Oncol, 2007, 25(18S): 3023.
4
Wu L, Adams M, Carter T, et al. Lenalidomide enhances natural killer cell and monocyte-mediated antibody-dependent cellular cytotoxicity of rituximab-treated CD20 (+) tumor cells [J]. Clin Cancer Res, 2008, 14(14): 4650-4657.
5
Shadduck RK, Latsko JM, Rossetti JM, et al. Recent advances in myelodysplastic syndromes [J]. Exp Hematol, 2007, 35(4 Suppl 1): 137-143.
6
Altekruse SF, Kosary CL, Krapcho M, et al. SEER Cancer Statistics Review, 1975-007. Bethesda (MD): National Cancer Institute, 2010.

URL    
7
Lu J, Lu J, Chen W, et al. Clinical features and treatment outcome in newly diagnosed Chinese patients with multiple myeloma: Results of a multicenter analysis [J]. Blood Cancer, 2014, 4: 239.
8
Palumbo A, Bringhen S, Ludwig H, et al. Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN) [J]. Blood, 2011, 118(17): 4519-4529.
9
Kumar SK, Rajkumar SV, Dispenzieri AA, et al. Improved survival in multiple myeloma and the impact of novel therapies [J]. Blood, 2008, 111(5): 2516-2520.
10
Kumar SK, Dispenzieri A, Lacy MQ, et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients [J]. Leukemia, 2014, 28(5): 1122-1128.
11
Durie BG, Harousseau JL, Miguel JS, et al. International uniform response criteria for multiple myeloma [J]. Leukemia, 2006, 20(9): 1467-1473.
12
Davies F, Baz R. Lenalidomide mode of action: linking bench and clinical findings [J]. Blood Rev, 2010, 24(Suppl 1): S13-S19.
13
Zhong YP, Zhang YZ, Liao AJ, et al. Geriatric assessment to predict survival and the risk of serious adverse events in elderly newly diagnosed multiple myeloma patients: a multicenter study in China [J]. Chin Med J, 2017, 130(2): 130-133.
14
Dimopoulos MA, Chen C, Spencer A, et al. Long-term follow-up on overall survival from the MM-009 and MM-010 phase III trials of lenolidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma [J]. Leukemia, 2009, 23: 2147-2152.
15
Hou J, Du X, Jin J, et al. A multicenter, open-label, phase 2 study of lenalidomide plus low-dose dexamethasone in Chinese patients with relapsed/refractory multiple myeloma: the MM-021 trial [J]. J Hematol Oncol, 2013, 6: 41.
[1] 陈慧, 姚静, 张宁, 刘磊, 马秀玲, 王小贤, 方爱娟, 管静静. 超声心动图在多发性骨髓瘤心脏淀粉样变中的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 943-949.
[2] 陈翠萍, 李佩君, 杜景榕, 谢青梅, 许一宁, 卓姝妤, 李晓芳. 互联网联合上门护理在老年全髋关节置换术后的应用效果[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 676-681.
[3] 陈晓玲, 钟永洌, 刘巧梨, 李娜, 张志奇, 廖威明, 黄桂武. 超高龄髋膝关节术后谵妄及心血管并发症风险预测[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 575-584.
[4] 曾敬, 吴冬冬, 邵明, 范震波, 王治国, 刘培谊, 兰海峰. 高龄髋部骨折患者不同手术时机的围手术期疗效评估[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 445-449.
[5] 刘哲魁, 马文星, 聂灵芝, 吴云桦, 单良, 王泽正. HALP评分联合术前检查预测老年胃癌淋巴结转移的价值[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 209-215.
[6] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[7] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[8] 袁志静, 黄杰, 何国安, 方辉强. 罗哌卡因联合右美托咪定局部阻滞麻醉在老年腹腔镜下无张力疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 557-561.
[9] 邵世锋, 肖钦, 沈方龙, 张迅, 郝志鹏, 伍正彬, 谢晓娟, 王耀丽. 老年胸主动脉钝性伤的重症救治分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 762-767.
[10] 天津市天津医院, 中国医师协会骨科医师分会肩肘外科学组, 国际矫形与创伤外科学会(SICOT)中国部肩肘外科委员会, 中国医疗保健国际交流促进会骨科学分会肩肘外科学部. 老年肱骨近端骨折诊疗策略中国专家共识(2024年版)[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 193-204.
[11] 王贝贝, 崔振义, 王静, 王晗妍, 吕红芝, 李秀婷. 老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 355-362.
[12] 张骞, 唐伟, 刘丽丽. 右美托咪定复合羟考酮对老年经皮椎间孔镜腰椎间盘切除术患者术后认知功能、镇痛效果的影响[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(04): 209-214.
[13] 鲁宁, 魏立友, 李亮, 张玉龙. 老年桡骨远端骨折小夹板治疗后早期腕关节功能恢复的相关因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(04): 222-228.
[14] 崔健, 夏青, 林云, 李光玲, 李心娜, 王位. 血小板与淋巴细胞比值、免疫球蛋白、心肌酶谱及心电图对中老年肝硬化患者病情及预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 400-406.
[15] 李忠清, 罗军. 尿蛋白电泳在浆细胞疾病鉴别诊断中的价值[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 217-221.
阅读次数
全文


摘要