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The Administration of Highdose Recombinant Human Erythropoietin in Multiple Myeloma Patients with Anemia

目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。

多发性骨髓瘤并眼底病变一例

Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple Myeloma: A Systemic Review

Objcetive　To assess the efficacy and safety of lenalidomide plus dexamethasone (LD) compared with placebo plus dexamethasone (PD) for relapsed or refractory multiple myeloma. Methods　Data were searched in The Cochrane Library (Issue 3, 2010), MEDLINE (with PubMed, 1966 to Nov. 2010), EMbase (1984 to Nov. 2010), CBMdisc (1978 to Nov. 2010), and CNKI (1979 to Nov. 2010), and also searched in clinical trials register for ongoing studies and completed studies with unpublished data. The references of the included studies and relevant supplement or conference abstracts were handsearched. Randomized controlled trials were included. The data were extracted, and then the quality of the included studies was assessed by two reviewers independently. RevMan 5.0 software was used for meta-analyses for studies with low heterogeneity. Results　Two studies involving 704 participants were included. One was high quality study, while the other was unclear about randomization and allocation concealment. The adverse outcomes of LD, such as mortality (RR=0.78, 95%CI 0.62 to 0.97, P=0.03) and incidence of disease progression (RR=0.16, 95%CI 0.08 to 0.34, Plt;0.000 01), were better than those of PD, which had significant differences. The overall response rate was higher in the LD group than in the PD group (RR=2.75, 95%CI 2.22 to 3.41, Plt;0.000 01). The incidence of thrombotic event (RR=3.20, 95%CI 1.78 to 5.73, Plt;0.000 1), the Grade Three and Grade Four neutropenia (RR=10.20, 95%CI 5.76 to 18.08, Plt;0.000 01), the Grade Three and Grade Four thrombocytopenia (RR=2.08, 95%CI 1.28 to 3.38, P=0.003), and the incidence of drug withdrawal or dosage reduction due to adverse reactions (RR=1.34, 95%CI 1.21 to 1.49, Plt;0.000 01) were all higher in the LD group than in the PD group. Conclusion　The efficacy of LD is superior to that of PD for relapsed or refractory multiple myeloma, but the incidence of drug adverse events, such as thrombosis, Grade Three or Grader Four neutropenia or thrombocytopenia, is also higher than that of PD, which has to be prevented positively.

以前段缺血性视神经病变为首发症状的多发性骨髓瘤一例

多发性骨髓瘤患者白内障术后眼内炎一例

多发性骨髓瘤并眼底出血（附二例报告）

报告2例多发性骨髓瘤合并眼底出血患者，并对其出血机制进行讨论，认为眼底出血同全身出血一样，均由于血小板异常减少与异常球蛋白血症所致。 （中华眼底病杂志，1993，9：114-114）

Analysis of curative effect, hospitalization cost and cost-effect of different treatments for patients with multiple myeloma

ObjectiveTo analyze the efficacy, hospitalization cost and cost-effect of different treatments for multiple myeloma, so as to provide references for the treatment and development medical insurance payment policy of multiple myeloma.MethodsA total of 60 cases of multiple myeloma patients who were treated in the General Hospital of Shenyang Military Command from January 1st, 2013 to December 31st, 2017 were included. According to the treatment method, they were categorized into the traditional treatment group (n=37) and novel drug treatment group (n=23). The total response rate and hospitalisation expenses for patients with medical insurance of the two groups were calculated and compared, and cost-effectiveness analysis was then performed.ResultsThe overall response rate in patients in traditional treatment group was 56.76% (21/37), and in novel drug treatment group was 82.61% (19/23) (χ2=4.366, P=0.039). The annual average drug fee, annual average novel drug fee, secondary average drug fee, secondary average novel drug fee, annual average total cost, and secondary average total cost of the medical insurance patients in the novel drug treatment group were significantly higher than those in the traditional treatment group (P<0.05). The annual average cost of personal and coordinated payment for the medical insurance patients in the novel drug treatment group were 172 229.53 yuan and 48 237.51 yuan, respectively, which were significantly higher than the traditional treatment group (P<0.01). The cost-effectiveness ratio of the traditional treatment group was 884.44 yuan/%, the novel drug treatment group was 2 821.80 yuan/%, the cost-effective incremental ratio was 7 075.75 yuan/%, the incremental cost-effective ratio was 7 075.75 yuan/%, and the sensitivity analysis was consistent with the results.ConclusionsThe total response rate of novel drug treatment is significantly higher than traditional treatment. However, novel drug treatment costs higher, and patient's economic burden is also higher. The traditional treatment is superior to novel drug treatment in cost-effectiveness analysis.

以胸腔积液为唯一表现的多发性骨髓瘤一例

多发性骨髓瘤（MM）是原发于浆细胞的恶性肿瘤，其临床表现为广泛骨质破坏，反复感染，贫血，高钙血症，高黏滞综合征，肾功能不全等。国内偶见多发性骨髓瘤并胸腔积液的报道，但以胸腔积液为唯一表现者尚未见报道。

Construction of Lentiviral Vector Containing Murine Vascular Endothelial Growth Factor Gene and Its Expression in NS-1 Murine Myeloma Cell Line

目的　构建含小鼠血管内皮生长因子（mVEGF）的重组慢病毒表达载体，包装成病毒颗粒后感染NS-1小鼠骨髓瘤细胞株，以便进一步探索VEGF在骨髓瘤病理生理机制中的作用。 方法　聚合酶链反应法扩增mVEGF基因，克隆入含嘌呤霉素抗性的pCDH慢病毒表达载体，构建出表达mVEGF的慢病毒表达载体pCDH-mVEGF；采用磷酸钙法将慢病毒系统三质粒pCDH-mVEGF、psPAX2、pMD2.G共转染293FT细胞包装病毒，分别收集转染后48 h和72 h病毒上清并感染靶细胞NS-1，初次感染72 h后开始采用嘌呤霉素筛选稳定株，筛选2周后采用ELISA法检测稳定株细胞培养上清中mVEGF的表达，建立出稳定高表达mVEGF的NS-1小鼠骨髓瘤细胞株。 结果　成功构建重组慢病毒表达质粒pCDH-mVEGF，并包装成慢病毒颗粒，感染NS-1细胞株后获得靶基因的稳定高表达。 结论　成功构建出含mVEGF的慢病毒表达载体pCDH-mVEGF，慢病毒系统能有效介导目的基因在NS-1小鼠骨髓瘤细胞株中稳定表达，病毒包装成功并能有效感染NS-1细胞，为进一步探索VEGF在骨髓瘤病理生理机制中的作用奠定了基础。

硼替佐米治疗多发性骨髓瘤的临床护理

目的　总结对多发性骨髓瘤患者采用硼替佐米药物期间的临床护理措施及经验。 方法　对2009年7月－2011年4月9例多发性骨髓瘤患者接受硼替佐米联合地塞米松、沙利度胺等治疗过程出现的不良反应，包括消化道反应、骨髓抑制、低血压和周围神经感觉异常等，采取对症有效的护理方法，使治疗安全顺利进行。 结果　9例患者完全缓解4例，部分缓解4例，轻微反应1例，用药过程中均未发生与护理相关的不良反应。 结论　应用硼替佐米时，要严密观察不良反应并及时予以对症处理，以保证治疗的顺利进行及效果。