The Clinical Observation Of Multiple Myeloma Treated With VHD Regimen And VAD Regimen

Objective:To observe the therapeutic effect of newly-diagnosed MM patients treated withVHD Regimen,and compared with the effect of VAD Regimen,to find whether VHDRegimen have superiority.To compare the therapeutic effect and the adverse reactionin MM patients who are treated by VHD regimen and VAD regiment,and provideclinical basis for the choice of VHD regimen.Methods:The clinical data of49patients who were diagnosed multiple myeloma and weregiven regular treatment of VHD regimen or VAD regimen3cycles from January2010to February2014in Hematology of The First Affiliated Hospital of ZhengzhouUniversity were analysed retrospectively.49patients were diagnosed according tothe domestic diagnostic criteria for multiple myeloma through the bone marrow cellmorphology, serum monoclonal immunoglobulin (M protein),and were stagedaccording to the Multiple Myeloma International Staging Standard (ISS) criterion，were classified according to the type of immunoglobulin and light chain，Collectingthe information of the49patients, including gender，age, blood routine,serum proteinelectrophoresis, Bence-Jonces protein,immunofixation electrophoresis, β2-microglo-bulin，albumin,urea nitrogen，creatinine, bone marrow cell morphology, etc.Therewere21patients in VHD group，including9males and12females，IgG12cases, IgA3cases, light chain6cases (κ light chain2cases andλ light chain6cases);stage I2cases, stage II7cases, stage III12cases.To evaluate the effect according to thedomestic diagnostic criteria for multiple myeloma,and get the response rate of every group.There were28patients in VAD group，including16males and12females，IgG10cases, IgA4cases, light chain14cases (κ light chain6cases andλ light chain8cases);stage I4cases, stage II6cases, stage III18cases.Calculate the response rateand side effect rate of each group,and compare the therapeutic effect and safety bychi-square test and t test.Chemotherapy regimens:VHD Regimen:Vincristine0.4mg/d ivgtt d1~4,Homoharringtonine2~4mg/d ivgtt d1~4,Dexamethasone40mg ivgttd1~4,d9~12,d17~20,28days a period.VAD Regimen:Vincristine0.4mg/d ivgttd1~4,Aclarubicin9mg/（m2d） ivgtt d1~4,Dexamethasone40mg ivgttd1~4,d9~12,d17~20,28days a period.Supporting treatments, such as liver protection,antiemetics and cardioprotection, were used in the chemotherapy course.Disphosphonate drugs were used in every period.The dosage of dexamethasone wasadjusted, depending on patients，age, glucose, blood pressure, infection, tolerance.Thalidomide tablets were taken by the patients of the two regimens.Results:To analyse the therapeutic effect in MM patients who are treated by VHDregimen and VAD regiment,there were49cases,the totally effective rate is67.35%.There were18cases treated with VHD regiment,sCR0，VGPR2cases(9.52%), CR2cases（9.52%），PR11cases（52.38%）.There were28cases treatedwith VAD regiment,sCR0，CR1case（s3.57%），VGPR2cases (7.14%), PR15cases（53.57%）。There was no significant difference of the totally effective rates betweenthe VHD regimen group and VAD regimen group(χ2=0.28，P=0.598). There were nosignificant differences between groups of light chain type patients（χ2=2.143，P=0.143）, as well as increase hemoglobi（nt=1.079，P=0.286）.However, there weresignificant differences in terms of reducing β2-MG（t=2.42，P=0.048）. There were nosignificant differences in terms of reducing bone marrow plasmaryt（eP=0.585）. VHDgroup and VAD group is20.36（6.2,24.3）、5.55(0.04,18.7) for reducing M protein orlight chain. There were no significant differences in terms of reducing M protein orlight chain（P=0.078）.In terms of Cardiac adverse reactions,there were1case of VHD regimen hasST-T segment change,The incidence of cardiac toxicity is4.762%;there were6casesof VAD regimen has ECG changes,2cases occur sinus tachycardia,3cases occur ST-T segment change,1case occur PAC,The incidence of cardiac toxicity is21.42%.The incidence of cardiac toxicity of two groups were compared by χ2test,there was significant difference of the incidence of cardiac toxicity between theVHD regimen group and VAD regimen group（χ2=2.722,P=0.034）.In terms of gastrointestinal adverse reactions, there were10cases in VHD group and12cases in VAD group, and the probability is47.6%vs42.86%. In terms of hepaticfunction damage, there were1case in VHD group and2cases in VAD group, and theprobability is4.76%vs7.14%.There were5cases in the two groups who occurred theperipheral nerve toxic reaction. The probability is23.81%vs17.86%. Infectionparients were6cases and9cases in the two groups, and infection rates were28.56%vs32.14%; Incidence of edema in the two groups were3cases, and the rates were14.28%vs10.71%.There were no significant difference of the adverse drug reactionsbetween the two groups.Conclusions:The totally effective rate of VHD regimen is similiar to VAD regimen,and has noadvantage in terms of increasing hemoglobin,but VHD regimen is better than VADregimen in terms of reducing β2-MG,and has less cardiac toxicity.VHD regimen issafer,and worth being used in clinic.