中文摘要：

目的探讨PAD（硼替佐米＋阿霉素＋地塞米松）方案治疗复发或难治性多发性骨髓瘤（MM）的疗效及安全性。方法17例复发或难治性MM患者给予硼替佐米（1．3mg／m^2，第1、4、8、11天快速静脉注射）、阿霉素（10mg／d，第1～4天静脉滴注）和地塞米松（40mg／d，第1～4天静脉滴注）治疗2～8个疗程，疗效评估依据国际2006疗效反应标准，毒性分级按美国国立癌症研究院不良事件通用名（NCICTCAE）v3．0判断。结果2～4个疗程PAD治疗后，14例（82．4％）患者获部分缓解（PR）以上疗效反应，其中完全缓解（CR）4例（23．5％），很好的部分缓解（VGPR）4例（23．5％），PR6例（35．3％），疾病稳定（SD）3例（17．6％），中位疾病进展时间为9．5个月，获疗效中位疗程数为1．6（1—3）个。其中5例合并髓外浆细胞瘤患者首次给予PAD方案即达PR以上疗效，1～2个疗程后髓外病灶消失。治疗过程中发现血小板减少9例（52．9％），白细胞减少4例（23．5％），周围神经炎4例（23．5％），带状疱疹3例（17．6％），乏力6例（35．3％），腹泻2例（11．7％）。以上不良反应经对症治疗后缓解或消失，1例患者于PAD治疗第5个疗程时发生进行性呼吸功能衰竭死亡。结论PAD方案可有效治疗复发或难治性MM，特别对伴有髓外浆细胞浸润的MM患者效果更为显著，疗效与传统化疗预后因素无关，常见不良反应经对症治疗可缓解，少数患者发生呼吸功能衰竭可能与硼替佐米潜在的肺毒性有关。

英文摘要：

Objective To investigate the efficacy and safety of PAD [ bortezomib （ PS-341 ）, doxorubicin and dexamethasone ] regimen for relapsed or refractory multiple myeloma （MM）. Methods Seventeen patients with relapsed or refractory MM received two to four 21-day cycles of PAD： an intravenous bolus of bortezomib （1.3 mg/m^2） on days 1, 4, 8, and 11 ; doxorubicin 10mg per day on days 1 to 4, and dexam- ethasone 40rag on days 1 - 4. Response was evaluated according to International Myeloma Working Group Criteria （IMWG 2006） , toxicity was graded according to NCI CTCAE （common terminology criteria for adverse events） v 3.0. Results After 2 -4 courses of PAD, 14 patients （82.4%） responsed, including complete response （CR） in 4 （23.5%）, very good partial response （VGPR） in 4 （ 23.5 % ）, partial response （PR） in 6 （35.3%） and stable disease （SD） in 3 （17.6%）. Median time to progression was 9.5 months. The median course to response was 1.6 （ 1 - 3 ）. All of 5 patients with extramedullary plasmaeytoma achieved at least PR after the first cycle therapy ; the plasmacytoma disappeared after 1 - 2 cycles of PAD. The efficacy was independent of other prognostic factors such as 132-MG. Adverse events included thrombocytopenia in 9 patients （ 52.9% ） , leukopenia in 4（23.5% ） , peripheral neuropathy in 4 （23.5%） , varicella herpes zoster in 3 （ 17.6% ） , fatigue in 6 （35.3%） and diarrhea in 2 （ 11.7% ）. All of these adverse reactions could be controlled with routine supportive treatmenlt, only one patient died from respiratory failure during his fifth PAD cycle. Conclusions PAD regimen should be considered as an appropriate treatment for relapsed or refractory MM, especially for MM with extramedullary plasmacytoma. Its efficacy is independent of traditional prognostic factors. The side effects are usually manageable.