Kröger Nicolaus, Zabelina Tatjana, Ayuk Francis, Atanackovic Djordje, Schieder Heike, Renges Helmut, Zander Axel
Department of Bone Marrow Transplantation, Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Exp Hematol. 2006 Jun;34(6):770-5. doi: 10.1016/j.exphem.2006.02.020.
We investigated the effect of at least two cycles of bortezomib (1.3 mg/m(2) intravenously, days 1, 4, 8, and 11) after dose-reduced allogeneic stem cell transplantation (SCT) on toxicity, CD3(+) cells, graft-versus-host disease (GvHD), and response in patients with multiple myeloma.
Eighteen patients with multiple myeloma without progressive disease were included. The proteasome inhibitor was given at median of 8 months after allografting to enhance or maintain remission status.
Fourteen patients (78%) completed the proposed two cycles. Four patients had to discontinue therapy due to neurotoxicity (n = 3) or gastrointestinal toxicity (n = 1). Severe grade III/IV toxicity was seen for thrombocytopenia (50%), leukopenia (17%), or neuropathy (17%), which was more often seen in patients treated concomitantly with cyclosporine (p = 0.06). The median circulating CD3(+) cells decreased during treatment from 550 muL to 438 muL (p = 0.03), resulting in herpes zoster infection in three patients (17%). In three patients, a mild aggravation of existing acute or chronic GvHD of the skin, and in one patient de novo skin grade I acute GvHD was noted. In patients with measurable disease, complete remission, partial remission, and minor response was seen in 3 (30%), 5 (50%), and 2 (20%) patients, respective.
Bortezomib after allogeneic SCT is effective but further studies are needed to balance the efficacy with potential hazards such as infectious complications, aggravation of GvHD, and neurotoxicity.
我们研究了在剂量降低的异基因干细胞移植（SCT）后给予至少两个疗程的硼替佐米（1.3mg/m²静脉注射，第1、4、8和11天）对多发性骨髓瘤患者的毒性、CD3⁺细胞、移植物抗宿主病（GvHD）及反应的影响。
纳入18例无疾病进展的多发性骨髓瘤患者。在同种异体移植后中位8个月给予蛋白酶体抑制剂以增强或维持缓解状态。
14例患者（78%）完成了拟定的两个疗程。4例患者因神经毒性（n = 3）或胃肠道毒性（n = 1）而不得不停止治疗。血小板减少（50%）、白细胞减少（17%）或神经病变（17%）出现严重的III/IV级毒性，在同时接受环孢素治疗的患者中更常见（p = 0.06）。治疗期间循环CD3⁺细胞中位数从550/μL降至438/μL（p = 0.03），导致3例患者（17%）发生带状疱疹感染。3例患者现有皮肤急慢性GvHD轻度加重，1例患者出现新发I级皮肤急性GvHD。在有可测量疾病的患者中，分别有3例（30%）、5例（50%）和2例（20%）患者出现完全缓解、部分缓解和微小反应。
异基因SCT后使用硼替佐米是有效的，但需要进一步研究以平衡疗效与潜在风险，如感染并发症、GvHD加重和神经毒性。
