To explore the efficacy of Qutan Huayu Tongbi Decoction combined with VRD regimen in the treatment of multiple myeloma (MM) with phlegm-stasis obstructing collateral syndrome.

A prospective randomized controlled placebo study was conducted, enrolling 132 MM patients with phlegm-stasis obstructing collateral syndrome admitted to the Department of Hematopathy of Qingyang Traditional Chinese Medicine Hospital from January 2022 to December 2024. Patients were randomly divided into two groups using a random number table. The control group (66 cases) received VRD chemotherapy combined with Chinese medicine placebo, while the observation group (66 cases) received VRD chemotherapy combined with Qutan Huayu Tongbi Decoction. Both groups were treated continuously for 4 cycles. The chemotherapy efficacy, TCM syndrome score, degree of bone pain, quality of life, blood biochemistry, coagulation indicators and adverse reactions were compared between the two groups.

The DCR (95. 45% vs 63. 63%), ORR (81. 82% vs 51. 52%), and the total effective rate of traditional Chinese medicine (93. 94% vs 77. 27%) in the observation group were all higher than those in the control group (P <0.01), while the overall incidence of adverse reactions was lower (7. 58% vs 22. 73% , P <0.05). After treatment, both groups showed a decrease in TCM syndrome score, bone pain Visual Analog Scale (VAS) score, and levels of vascular endothelial growth factor (VEGF), derived neutrophil-to-lymphocyte ratio (dNLR), neutrophil-to-lymphocyte ratio (NLR), bone marrow plasma cell proportion, β2-microglobulin (β2-MG), lactate dehydrogenase (LDH), serum creatinine (Scr), blood urea nitrogen (BUN), D-dimer (D-D), and plasma fibrinogen (FIB) compared to before treatment (P < 0.01), with the observation group showing lower values than the control group (P < 0.01). The lymphocyte-to-monocyte ratio (LMR), hemoglobin (Hb), Karnofsky Performance Status (KPS) score, and Activities of Daily Living (ADL) score increased compared to before treatment (P < 0.05), with the observation group showing higher values than the control group (P <0.01). Prothrombin time (PT) and activated partial thromboplastin time (APTT) were prolonged compared to before treatment (P < 0.01), with the observation group showing longer times than the control group (P < 0.01).

The combination of Qutan Huayu Tongbi Decoction and VRD chemotherapy regimen can effectively enhance the therapeutic effect of chemotherapy for multiple myeloma, alleviate clinical symptoms, bone pain and anemia, improve coagulation and renal functions, regulate immune inflammation, enhance the physical condition and quality of life of patients, and has good safety.