DIEN D A N YHOC
Nghien cu-u khoa hpc
OANH GIA HIEU QUA DIEU TRI OA U TUY XU'ONG
BANG PHAC 0 6 VAD TAI KHOA HUYET HOC-TRUYEN MAU BENH VIEN BACH MAI Tir 1/2008 OEN 3/2009
Nguyen Thj Lan*, Pham Quang Vinh*, Vu Minh Phuong*, Nguyen Thi Lan Huong*, Han Viet Trung*, Nguyen Tuan Tiing*, Phan Thj Hien Luong*, Vuong Son Thanh*
TOM T A T
Da 11 liiv xuong Id benh ung lliir ddng lirong hdo. Hien luiv. cd nhieu phac do dd dirge dp dung. Irong dd I AD dugc su dung cd hieu qua. phii hop vdi dieu kien kinh le cua Viet .Nam. 17 vdv. chiing ldi lien hdnh nghiin ciru: "Ddnh gid hieu qua dieu Iri da u liiv xuong hdng phde dd VAD Igi khoa Hiivel hgc - Truven mdu. Benh vien Bgch Mai lir 1 2008-3 2009". Muc tieu: /. Ddnh gid hieu qua dieu Iri da ii luy xirong bdng phde dd VAD. 2. Ddnh gid ldc dung phu cua phde do. Ddy Id mdi nghien ciru liin cim md la cdl ngang lien hdnh Iren 41 benh nhdn dugc chdn dodn xdc dinh da ii luv xinnig lgi khoa Hiivel hgc - Truven mdu. Benh vien Bgch Mai. Ket qua: Tmh Irgng thieu mdu vd mirc lgc cdu llign dugc cai thien rd ret Irirdc vd sau dieu Iri VAD. (Hb Irung binh Irirdc dieu Iri 88g/l. sau dieu Iri 104 gd. Mirc lgc cdu than hinh ihirdng Irudc dieu Iri 63.4%. sau dieu Iri' 80.5%)). Tinh Irgng dau xuong. sd lugng bgch can. lieu cdu il thay ddi so vdi Irudc dieu Iri. Bien chimg: rung ldc 100%, ndn: 52.2%i. nhiem Iriiiig 12.2%i.
Tir khba: phde do VAD. da ii luy xuinig.
I.DATVANDE
Da u tiiy xirong lii benh ung thu dong tuong bao (Plasma cells), thuoc tuy xirong vdi sir co mat eiia ton thuong xuong. tang tuong bao non. xuiit hien protein don dong trong huvet tuong va nude tieu. dau xirong. tiing Ca++ miiu va thieu miiu.
Da u tuy xuong lii mgt the cua ung tlur tuong bao (plasma cell - neoplasma) [ I ].
Trong da u tiiy xuong, ngudi ta phat hien nhieu tbn thuong nhiem siic the va gen nhu dot bien gen ung thu RAS. Ngoai ra. Interleukin - 6 dugc coi la veil to kich thich sinh miiu tiem tiing trong da u tuv xuong. Te bao dong tuong bcio trong benh da u tuy xuo-ngsan xuiit immunoglobulin (Igidon dong benh ly vbi so lugng ldn. diin tdi tinh trc^ng tiing protein huyet tuong chu yen do immunoglobulin benh ly.
gicim Ig binh thuong. giiim albumin. Ton thuong xuong thudng gap trong da u tiiy xuong dugc cho la do yen to phiin liiiy khbi u (TNF) va/ hoac IL- 1 do te bao ac tinh dong tuong bao tiet ra. Benh vdi cac bieu hien benh ly: khuyet vii loiing xirong, giam sinh tuy. Tiing tuong biio tai tuy xirong, tang do nhot mau, tiing protein don dong, giam chirc nang than hoac suy than. Cac yeu to tien lirgng ,\au cua benh la: protein man tang eao, albumin mau giam, tang nhieu plasmocyte, CRP> 6, roi loan ehiie nang than, suy than, giam nhieu cac dong mau, tang (32 microglobulin [4], [5], [7], [8].
Hien nay. tren the gidi dii cip dung nhieu phac do dieu trj khiic nhau doi vdi benh nhiin da u tuy xuang (MR VMCP, VAD, MPT, Tha-Dex, Boitezomid, ...). Trong phcac dd VAD, ngOcii cac
Khoa Hiivel hoc - Truven mdu. Benh vien Bach .Mai
Nghien cu-u khoa hgc
thuoc chinh dieu trj, benh nhan dugc dieu tri ho trg them mgt sd thuoc nhir: thudc chdng tieu xirong biphosphonat (Aredia). thuoc kich thich tiing tcio hdng ciiu (Erythopoietin). thuoc chbng loiing xuong va giam Ca+-i- lUciu (Calcitonin. Biphosphonat. Ze- dronic acid...) va dimg cac thuoc ho trg khcic. 0 Viet Nam. trirdc day phcic dd VAD tluri-ing dugc ap dimg cho eiic benh nhim da dugc dieu trj being phac do MP nhirng khdng co hieu qua. Hien nay.
mgt so noi o' Viet Nam da ap dung phac do VAD nhu la phac do dieu trj dau tay. dae biet a Ccic benh nhan ed ehi djnh ghep tuy xuang. benh nhiin < 65 tubi. khong mac cac benh ly ngi khoa kem theo.
Tuy nhien, cho den nay cac nghien ciru ve tac dung va hieu qua cua phac do nay con chua dugc thbng ke vii tong ket day du. Vi vay. chimg tdi tien hanh nghien ciru de tai nay nham 2 muc tieu:
/. Budc ddu ddnh gid hieu qua dieu Iri da u luy xuong bdng phde dd V.4D.
2. Ddnh gid ldc dung phii cua phde dd VAD trong dieu tri da u luy xirong.
i n . DOI TUONG VA PHUONG PHAP NGHIEN CUU
1. Dbi tuong
41 benh nhan dugc chan doan \ac djnh la da u tiiy xuong theo tieu chiiiin ciia Bart - Barlogie 1995, tai khoa Huyet hgc - Truyen mau tir thang 1/2008 din thang 3/2009 [6].
2. Phuong phap nghien ciiu
2.1. Phirang phdp chgn mdu nghien ciru
Tieu chudn chgn benh nhdn: benh nhan dugc chiin doan xac djnh la da u tiiy xuong theo tieu chuan cua Bart - Barlogie 1995 tai khoa Huylt hgc VCT Truyin mau. Benh vien Bach Mai tir thang 1/2007 din thang 1/2008 va dugc dieu tri theo phac do VAD tir 6-8 dgt.
Tieu chudn chdn dodn cua Bart - Barlogie 1995:
a. Tieu duuln chinh:
I. Co u tuang biio tren sinh thiet tuy hoac a mgt tb chirc.
2. Cac te biio thuoc dong tuong bao > 30% trong tuv.
3. Protein M tiing trong mau hoiic nude tieu + IgG > 3.5g/dl hocic IgA > 2 g/dl hoiie + Chiioi nhe > lg/24|-| trong nuac tieu b. Tieu cluiiin phu:
4. ('lie te beio tluige dong tuong biio 10-30% trong tuy.
5. Protein M tiing dudi mirc tren.
6. Ton thuong tieu xirong tren phim X quang 7. Giam Ig binh thuiing trong mau: IgM < 5mg/dl:
IgA< 10 mg/dl; IgG< 60 mg/dl.
Chcin doan xac djnh khi co it nhat I tieu chuiin chinh vii 1 tieu chuan phu hoac eo it nhiit 3 tieu chuiin phu.
Phac db VAD |6|:
Vineristin: lieu dimg: 0.4 mg tiem tTnh mach/ ngay, ngay 1-4.
Doxorubiein: lieu dimg: I0mg/m2 truyen tTnh mach/ ngay, ngay 1-4.
Dexamethason: Lieu dimg: 40mg truyen tTnh mach/ ngay, ngay 1-4.
Tiiu chudn logi Irir:
Benh nhan dugc chan doan da u tiiy xirong nhung cb mgt trong nhirng tieu chuiin sau khi chimg toi khong chi djnh dieu trj theo phac do VAD.
8. Benh nhcin tren 65 tuoi.
9. Benh nhan co benh kem theo: block nliT thiit hoae block nhanh. suy tim.
10. Benh nhan mac benh viem da day dang trong dgt cap.
2.2. Chi tiiu theo ddi vd ddnh gid kit qud
* Ldm sdng:
- Tinh trang thieu mau.
- Tinh trang dau xuang. vj tri dau xu-ong.
* Xel nghiem: tien hanh theo cac moc thai gian trudc khi viio dieu tri dgt diiu va sau khi ket thiic phac do dieu trj VAD (kiem tra khi nhap vien sau khi ket tliiic phiie dd dieu trj).
- Cong thirc mau: kiem tra so lugng hong ciiu. HST.
S6 50 (Thang 03/2010) Y HOC L A M S A N G I 19
DIEN D A N Y HOC
Nghien CI^U khoa hoc
bach cau, ebng thirc bach eau, tieu eau. 2.3. Phwang phdp nghien ewu: phuang phap mb ta - Mien djch: djnh lugng eae Ig mien djeh IgA, IgE, eat ngang,va tien ciru.
IgG, IgM. ^^ ^^ j ^ ^A j . . ^ _ ^^^^ chuang trinh SPSS 13.0.
- Chan doan hinh anh: chyp X quang xuong det (sg, CSTL, chau, ngyc).
III. KET QUA NGHIEN CUU
Trong tong sb nghien ciru eb 41 benh nhan do tubi tii' 40-65.
1. Phan bo benh theo tuoi
Bdng 1. Phdn bd ve tudi mdc benh
Tuoi 4 0 - < 5 0 50 - <60 60-65 Tdng
7i/d/ trung binh
So lu'ong n = 41
7 23
11 41
% 17,1 56,1 26,8 100%
566+7,2 Nhdn xet: tubi trung binh trong nghien eiin la 56,6.
2. Phan bo benh nhan theo gioi
Bieu do 1. Phdn bd benh nhdn theo gi&i Nhdn xet: benh gap b nu nhieu hon nam.
3. Thay dot ve lam sang trube va sau dieu trj sau khi dieu trj 1 dot Bdng 2. Thay ddi ve ldm sdng sau khi dieu tri Benh nhan
Thieu mau Khdng thieu mau Dau xuong Do dau xuong Tbng so
Trube dieu trj n=41
35 6 41
41
%
85,37 14,63 100
100
Sau dieu trj n=41
27 14 31 10 41
%
65,85 34,15 75,6 24,4 100 Nhdn .xet: trudc dilu tri 85,37% benh nhan thilu mau, 100% benh nhan dau xuong.
Nghien cu-u khoa hpc
4. Thay dbi ve chi so xet nghiem huyet hoc
Bang 3. Thay ddi ve chi sd huyet sdc to (Hh) trirae vd sau dieu tri H b (g/l)
> 120 8 0 - < 120
6 0 - < 80
< 6 0 Hb trung binh (g/l)
Truoc dieu t r j n
6 24
7 4
% 14.6 58.5
17.1 9.8 88,0 ±18,1
Sau dieu t r i /;
14 21 6 0
% 34,1 51,2 14,6 0 104.0± 14,6
P
< 0.05
Nhdn xel: Hb trung binh trudc dieu trj 88g/l. sau dieu trj tang 104 g/l.
Bdng 4. Thay ddi chi so hgeh cdu, tiiu cdu truac vd sau dieu tri BC (G/I)
> 10 4 - 10
< 4
BC trung binh (G/l) TC (G/l)
> 150 I 0 0 - < 1 5 0 5 0 - < 1 0 0
< 5 0
TC trung binh (G/l)
Trudc dieu trj n
1 30
4
% 17.1 73.2 9.7 6.3 i-2.9( 2.8 ^ 16,1)
//
26 5 8 2
% 63,4
12,2 19,5 4,9 185 ± 97 ( 1 5 : 5 1 1 )
Sau dieu t r j //
13 27 1
% 31,7 65,9 2.4 5,6 ±2.5 (2,21 - 12,6)
n 25
11 4
1
% 61 26,8
9,8 2,4 180 ± 8 2 ( 3 0 - 3 0 2 )
P
>0,05
>0,05 Nhdn xel: so lucing bach eiiu va tieu ciiu trude Vei sau dieu tri khong thay doi.
5. Thay dbi xet nghiem sinh hoa
Bdng 5. Bien ddi mirc lgc edu than trade vd sau dieu tri
Miic loc cau than (ml/ phut)
> 9 0 6 0 - 8 9 3 0 - < 6 0
1 5 - < 3 0
< 15 Tong
Trube dieu trj //
26 6 4
2 41
% 63.4
14.6 9,8 7.3 4.9 100%
Sau dieu t r j n
0 4 1 41
% 80,5
7.3 0 9,8 2,4 100%
P
<0,05
<0.05
<0,05
<0,05
<0,05 Nhdn xel: mirc lgc can than binh thudng sau dilu tri tciiig ro ret la 80,5%.
S6 50 (Thang 03/2010) Y HOC L A M S A N G I 21
DIEN DAN
YHOC
Nghien cu'u khoa hpc
6. Nhung thay dbi xet nghiem mien djch
Bdng 6. Nhdn xet ve thay ddi Protein mdu todn phdn. Albumin vd Glohumin
lgA(mcg/l) n=9
> 82 g/l
< 82 g/l
>3000 2000 - 3000
< 2000
>2000 1500-2000
< 1500
Trube dieu trj Ty I?
23/41 18/41 25/26 1/26
0 6/9 3/9 0
% 56,1%
43.9%
96,1%
3.9%
0 66.7%
33,3%
0
Sau dieu t r i Tyle
7/41 34/41
10/26 8/26 8/26 4/9 3/9 2/9
% 17.1%
82.9%
38,5%
30,7%
30.7%
44.4%
33,3%
22,2%
P
<0,05
<0.05
<0,05
<0,05
<0.05
<0.05
<0,05
<0,05
Nhdn .xel: protid tOcin phan > 82g/l trudc dieu trj la 56,1%. sau dieu trj giam con 17.1%
7. Thay dbi trong xet nghiem chan doan hinh anh
Bdng 7. Thay ddi trong xet nghiim chdn dodn hinh dnh
Ty Ie dot xuong, tieu xu'O'ng dien hinh
Cb 1-3 vj tri xuong Cd > 3 vj tri xuong Khong
Tong
Tru'b'c dieu trj Sd lugng
BN 18 7 16 41
% 43.9
17,1 39 100
Sau dieu trj Sd lugng
BN 13 4 24 41
% 31,7
9,8 58,5
100 Nhdn xel: ton thirong xirong > 3 vj tri trude dieu trj la I 7.1%, sau dieu trj giam con 9,8%.
8. Tae dung phu va bien chung tren benh nhan du'O'c chi djnh dieu trj phae db VAD
Trong so 41 benh nhan trong nghien ciru eiia chimg toi khi dugc dieu trj biing phiie do VAD:
100% benh nhan bj rung toe. co 21 benh nhan chiem 51,2%, bien chimg nhiem triing sau dieu trj cd 5 benh nhan chiem 12,2%.
IV. BAN LUAN
1. Phan bb ve tubi mac benh
Bang 1 eho thay: tuoi tir 40-70 tuoi. tuoi trung binh ciia cac benh nhiin la 56,6 ± 7,2. Trong do.
nhom tuoi tir 50-60 chiem 56,1%. Khong gap tuoi dudi 40 va tren 70.
Nghien ciru phii hgp vdi eac nghien ciru tren the gidi. Theo Barlogie B thi do tuoi thudng gap la 40-70. dae biet la tir 50-60, it gap d cac benh nhan tre hon 40 va tren 80. So sanh vdi nghien ciru ciia mgt so tac gia khac b Viet Nam ehimg toi thay khbng cb sy khac biet [4]. [6], [9].
2. Phan bb benh nhan theo gibi
Bilu do I cho thiy: cb 19 nam (46.3%) va 22 nir (54,7%), ty le nam/ nir : 0,86. So Scinh vbi
Nghien ci>u khoa hpc
nghien ciru ciia Vd Thi Thanh Binh. Tran Van Be.
Do Trung Phan (ty le nam/nir gan 1:1). [2]. [3]. [4].
Theo cong bo cua WHO 2001 [4] thi ty le nam/iur la 3/2 [4].
3. Thay doi ve trieu chiing lam sang
Bang 2 eho thay: thieu man la trieu chirng hay gap a benh nhan Kahler. chu yeu la do tuy sinh man bj liin lit bdi cac te biio ung thu. Mat khae. so benh nhan thieu mau khi vao vien chiem 85.37%. sau khi ket thiie phac do VAD thi so benh nhiin con bieu hien lam Scing thieu man con kii ki 65.85%.
Nhir vay. sau dieu trj thieu man dugc cai thien. tuy nhien, ty le benh nhan thieu man van chiem ty le kha cao.
4. Thay doi ve chi so xet nghiem huyet hoc Bang 3 eho thay: sau khi dieu trj. henh nhiin dugc cai thien rd tinh trang thieu mau, huyet sac to trung binh trudc dieu trj la 88 g/l; sau dieu trj la
104 g/l.
Bang 3. bang 4 cho thay: trudc dieu trj Hb >
120 g/l chiem 14.6%. so benh nhan cd Hb giam nhe tir 80 - < 120 g/l lii 58.5%. benh nhan co Hh giam tir 60 - < 80 chiem 1 7.1 % Vci co 9,8% benh nhiin thilu mau nang (Hgb < 60 g/l). Sau dieu trj benh nhan khong thieu mau ed Hb > 120 g/l tang len 34.1%.
khong con benh nhan thieu mau nang (Hb<60g/I).
Dieu nay ehirng td sau khi dieu trj trieu chirng thieu mau d benh nhiin da dugc eai thien ro ret.
So lugng bach Cciii (so lirgng BC): trude dieu tri, ty le benh nhiin cd so lirgng BC < 4 G/L chiem 9,7 % . so benh nhcin cd so lugng BC tir 4 - 1 0 G/L ki 73.2% va 14.1% benh nhiin cb s6 lugng BC > 10 G/L. Sau dieu trj. ty le benh nhan co so lugng BC <
4 G/L ehilm 2,4%. benh nhiin c6 BC tir 4 - 10 G/L Ici 65,9. So lugng bach cau trung binh trudc dieu trj va sau dieu trj it thay doi. Chimg toi khong gap trudng hgp nao phai su dung den thuoc kich bach ceiu (G - CSF hocic G M - CSF).
Sd lugng tieu ciiu (so lugng TC): trudc dieu trj. benh nhan cb so hrgng TC < 150 G/L chiem 34.2 %. benh nhiin ed so lugng TC tir 150 - 450 G/L 111 63,4% va eo 2.4% benh nhan co so lugng TC > 450 G/L: sau dieu tri. benh nhcin co so lugng TC < 150 G/L chiem 36.6 %. Tieu eiiu trung binh trudc va sau dieu trj khong tray doi. deu ki 180G/I.
Dieu niiy cho thay phiic do VAD khong gay giam tieu cau.
5. Nhung thay dbi xet nghiem sinh hba
Being 5 cho thay: trudc dieu trj: 63.4% benh nhan co mirc Igc cau than binh thudng (>90in/
phiit), sau dieu trj tang 80,5% benh nhan co mirc Igc eau than > 90 ml/ phiit. Nhu vay, phae do V A D dieu trj cho benh nhan da u tiiy xuong da ca thien rd ret trieu chirng suy than. Tuy nhien, ehimg toi ciing thiiv riing doi vdi nhirng benh nhiin co mirc Ige ciiu than < 30 ml/ phiit thi trieu chirng suy than khong cai thien.
6. Nhu'ng thay dbi xet nghiem mien djch
Being 6 cho thay: trudc dieu trj, ty le benh nhan co protein miiu toan phan tang > 82 g/l len tbi 56,1%, nhbm tiing protein ehii yen thuoe nhom Kahler Ig G, ty le Albumin giam dudi 35 g/l la 56,1%; sau dieu trj dii eb sir eai thien dang ke, ty le BN CO protein mau toan phan > 82 g/l giam eon 17.1%: ty le albumin giam duoi mire binh thuong eon 46.3%. eo 82.9% benh nhiin ed xet nghiem pro- tein tra ve binh thubng (< 82g/l). Dieu nay chirng td dap irng dieu trj ciia benh nhan khii tot sau dieu trj phae do VAD.
7. Thay do! trong xet nghiem ehan doan hinh anh
Bang 7. cho thiiy: ty le ton thuong xirong dien hinh tren phim X quang xuong trude dieu trj la 6 1 % , trong do hinh anh tdn tlurong xuong dien hinh gap d 1-3 xiro-ng lii 43,9% vii ton thuong lan
S6 50 (Thang 03/2010) Y HOC L A M S A N G I 23
DIEN D A N YHOC
Nghien cu'u khoa hpc
toa tOcin thcin (nhieu xirong) la 17.1% vci khong co ton thuong xuong dien hinh la 39%. Trong cac benh nhcin co tdn thuong xuang thi chu veu gap xuong sg (65.8%). xuong CSTL 41.5%. xuong sircm 24.4%, xiro-ng chau 34.1%. Sau khi dieu trj phac do VAD thi ty le benh nhcin co ton thuong xuong tren phim X quang co giam. trong do ty le ton thuo-ng xuo-iig dien hinh tren phim X quang xirong la 41.5%.
trong do ty le ton tlurong xuong dien hinh gap o 1-3 xirong giam con 31,7% vii ton tlurong lan toa toan than (nhieu xirong) la 9,8% va khong cb ton thuo-ng xirong dien hinh la 58,5%. Dieu nay chirng to phiie do VAD cimg vdi ciic thuoc ho trg chong tieu xirong da ciii thien tinh trang ton thuong xirong cua benh nhiin.
8. Tac dung phu va bien chii'ng tren benh nhan diroe chi djnh dieu trj phac db VAD
Tae dung phu nbn gap kha pho bien a benh nhan dieu trj VAD gap 51,2%, rung toe gap 100%
benh nhan. Benh nhan dieu trj phac do VAD co bien chimg nhiem triing gap 12,2%, ty le nay kha cao va dae biet nguy hiem do hg bj suy giam mien djch trong khi hg mac phai nhirng nhiem triing benh vien.
Chimg toi thay benh nhan sau dieu trj phac db VAD cb gay giam bach can nhung khong giam nhieu. Tuy nhien, dieu kien benh phong chat hep, sb lugng benh nhan qua tai, benh nhan phai nam ghep chinh la mgt trong nguyen nhan gay nhiem triing cho benh nhan.
V. KET LUAN
Nghien ciru 41 benh nhiin dugc chan doan Kahler tai khoa Huyet hgc - Truyen mau, chimg toi eb mot so nhan xet sau:
L Nhung thay dbi ve lam sang va xet nghiem trudc va sau dilu trj mot dot VAD
- Ldm sdng
+ Tinh trang thieu man dirge cai thien rd. Trudc dieu trj CO 85,37% thieu mau. Sau dieu tri giam con 65,85% thieu mau.
+ Trieu chimg dau xirong chua dugc cai thien tot:
trudc dieu trj 100% cb dau xuong. sau dieu trj chi CO 24.4% da dau. 75.6% khong dd dau xuang.
- Xet nghiem
+ Hemoglobin truac dieu trj co 9.8% benh nhan thieu mail niing (Hb< 60 g/l), sau dieu trj khong co benh nhan nao thieu mau nang. Trudc dieu trj Hb trung hinh 88g/l. sau dieu trj Hb trung binh la 104 g/l. Sir khae biet c6 y ngliTa vdi p < 0.05.
± So lugng bach can trube va sau dieu trj it thay doi: trudc dieu trj so lugng bach can trung binh 6.3 G/l. sau dieu trj so lugng bach eau trung binh 5.6 G/l.
± Sb hrgng tieu cau trube va sau dieu trj khbng thay doi. Trudc dieu trj so lugng tieu eau trung binh la 185 G/l, sau dieu trj so lugng tieu can trung binh la 180 G/l.
± Mirc Igc cau than dugc cai thien ro ret: tnrdc dieu trj 63,4% benh nhan cd mirc lgc cau than binh thudng. sau dieu trj la 80,5%.
± Protein man toan phan: trude dieu trj 56,1 % benh nhan CO protein tang tren 82 g/l, sau dieu trj ehi eon 17,1%.
± Thay doi trong xet nghiem ehan doan hinh anh:
sau dieu tri ty le dot xuong, tieu xuong da dugc cai thien. Truac dieu trj, so benh nhan eo hinh anh tieu xuong b 3 vj tri lii 6 1 % , sau dieu trj giam cdn 41,5%.
2. Nhung tac dung phu va bien chirng b benh nhan du'oc dieu trj phac do VAD: nbn chiem 52,2% benh nhan. Rung tbc: 100%. Nhiem triing:
12,2%.
TAI LIEU THAM KHAO
/. Nguyin Thi Minh An (2000), "Benh Kuhler". Bui giang Benh hgc Bpi khoa, lap I. N.XB Y hgc. [rang 238-245.
Nghien ci^u khoa hpc
2. Vo Thi Thanh Binh (2001). "Nghien ciru su cd mat cua mpi sd cytokine (IL-lfi. IL - 6. TNFa) vd f)2 microglobulin Irong benh da u luvxinnig". Ludn vdn lot nghiep hdc sy ngi Iru.
3. Trdn Vdn Be (1998). "Da u luy xirong vd benh y globulin dan ddng. Ldm sdng huyet hgc ". NXB Y hgc.
4. Do Trung Phdn (2003). "Da u luv xinnig. Benh ly le bdo ngudn Igo mdu ". NXB Y hgc. Irang 333-346.
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SUMMARY
THE EFFECT OF VAD REGIMEN IN MULTIMYELOMA PATIENTS IN HEMATOLOGY - BLOOD TRANSFUSION DEPARTMENT, BACHMAI HOSPITAL FROM 1/2008-3/2009
Mullimyeloma is a plasma cell malignant. Today, many regiments have been applied. VAD regiment has been known a very effective, suitable for Vietnamese miilimyeloma putients. Aims: lo assess the effects and complications of VAD regimen in mullimyeloma palients. This is u prospective, cross - sectional study carried out in 30 mullimyeloma patients in Hemalolog}' - Blood Trunfusion depurtment. Results: after I circle
VAD regiment, anemic signs and kidney clearance were clearly improved (averuge Hb, before treufmenl:
88g/l, after treatment: I04g/I. normal value kidney clearance, before treatment: 63.4%. after treufmenl:
80.5%)). On the other hand, bone pain, while blood counls undplulelel counts were little changed. Lastly the common side effects and compliealions were elopecia: 100%). nausea: 52.2%. Infection: 12.2%.
Key words: VAD regiment, mullimyeloma.
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