Reduced risk of bacterial infection in multiple myeloma patients with VAD regimen without intermittent high-dose dexamethasone
Reduced risk of bacterial infection in multiple myeloma patients with VAD regimen without intermittent high-dose dexamethasone
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DOI：
10.1007/s12185-010-0735-1
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发表时间：
2011-01-01
影响因子：
2.1
通讯作者：
Sawamura, Morio
中科院分区：
文献类型：
--
作者：
Isoda, Atsushi;Matsumoto, Morio;Sawamura, Morio
长春新碱-阿霉素-地塞米松(VAD)联合间歇大剂量地塞米松(HD)方案已被用作多发性骨髓瘤(MM)患者的主要化疗方案，这些患者适合大剂量治疗或合并肾功能衰竭。然而，地塞米松增加了多发性骨髓瘤患者感染的风险。我们对接受VAD治疗的MM患者的治疗效果和感染事件进行了回顾性评估。对在我所接受VAD治疗的77名患者进行了评估，其中37名患者没有HD，40名患者接受了VAD-HD。对患者的特征和VAD方案进行了回顾分析，以检测与感染发生率的相关性。在218个VAD周期中，39名患者发生了48次感染。其中，26例患者的32次发作为严重(3级)。通过对每个患者的分析，VAD-HD与所有级别和严重细菌感染的风险相关，而国际分期系统分期<gt；=2与严重细菌感染独立相关。两个周期后的有效率在两种VAD方案之间是相似的。综上所述，无HD的VAD的感染风险低于VAD-HD，且临床反应相同。因此，对于感染风险较高的MM患者，应避免使用VAD-HD。
Vincristine-adriamycin-dexamethasone (VAD) regimen with intermittent high-dose dexamethasone (HD) has been used as primary chemotherapy for multiple myeloma (MM) patients who are candidates for high-dose therapy or present with renal failure. However, dexamethasone increases the risk of infection in MM patients. We retrospectively evaluated treatment efficacy and infectious events in MM patients undergoing VAD with or without HD. Seventy-seven consecutive patients who received VAD without HD (n = 37) or VAD-HD (n = 40) at our institution were assessed. Characteristics of patients and VAD regimens were retrospectively analyzed to detect correlations with the incidence of infections. During 218 VAD cycles, 48 infectious episodes were documented in 39 patients. Of these, 32 episodes in 26 patients were severe (grade >= 3). By analyzing each patient, VAD-HD was associated with risk of all-grade and severe bacterial infection, while International Staging System stage >= 2 was independently correlated with severe bacterial infection. Response rates after two cycles were comparable between the 2 VAD regimens. In conclusion, risk of infection is lower in VAD without HD than in VAD-HD, and the clinical response is equivalent. VAD-HD should thus be avoided for MM patients with high risk of infection.