Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA.
Cancer. 2010 Jul 1;116(13):3143-51. doi: 10.1002/cncr.25143.
This single-center retrospective study determined the efficacy of bortezomib, thalidomide, and dexamethasone (BTD) as induction for patients with multiple myeloma (MM) who were eligible for autologous stem cell transplantation (ASCT).
Patients with symptomatic MM who had received BTD induction before stem cell collection at Winship Cancer Institute were included. BTD induction comprised up to 8 3-week cycles of bortezomib 1.3 mg/m(2) on Days 1, 4, 8, and 11; thalidomide 100 mg daily; and dexamethasone 40 mg on Days 1 through 4 and Days 9 through 12. Stem cell mobilization involved granulocyte-colony-stimulating factor and/or cyclophosphamide. Response was assessed according to European Group for Blood and Marrow Transplantation criteria.
Review of medical records identified 44 eligible patients (34 patients who were treated in the front-line setting and 10 patients who were treated for recurrent disease) who received a median of 4 BTD cycles. The overall response rate (ORR) was 91%, which included a greater than or equal to very good partial response (> or = VGPR) rate of 57% (including 20% stringent complete responses/complete response [sCR/CR] rate). In front-line patients, the ORR was 94%, which included a 56% > or = VGPR rate (24% sCR/CR). The median CD34-positive stem cell collection was 10.67 x 10(6)/kg. The ORR after ASCT in 34 patients who were evaluable for response was 100%, including a 76% > or = VGPR rate (53% sCR/CR). Among all 44 patients, the median progression-free survival (PFS) was 27.4 months. The median overall survival (OS) was not reached after a median follow-up of 25 months, and the 2-year OS rate was 82%. There were no significant differences in PFS (27.4 months vs 23.5 months) or in 2-year survival (80% vs 90%) between patients who did and did not undergo ASCT, respectively. Twenty patients (45%) developed neuropathy, including 4 (9%) with grade 3 neuropathy episodes, and 1 patient developed deep vein thrombosis.
BTD was highly effective and well tolerated as induction for MM patients who were eligible for ASCT. Long-term outcomes appeared to be similar with or without ASCT consolidation.
这项单中心回顾性研究确定了硼替佐米、沙利度胺和地塞米松（BTD）作为适合自体干细胞移植（ASCT）的多发性骨髓瘤（MM）患者诱导治疗的疗效。
在温希普癌症研究所采集干细胞前，接受 BTD 诱导治疗的有症状 MM 患者被纳入研究。BTD 诱导包括多达 8 个 3 周周期的硼替佐米 1.3mg/m(2)，于第 1、4、8 和 11 天给药；沙利度胺 100mg/d；地塞米松 40mg 于第 1 天至第 4 天和第 9 天至第 12 天给药。干细胞动员涉及粒细胞集落刺激因子和/或环磷酰胺。根据欧洲血液和骨髓移植协会（EBMT）标准评估反应。
对病历的审查确定了 44 名符合条件的患者（34 名一线治疗患者和 10 名复发性疾病患者），他们接受了中位数为 4 个 BTD 周期的治疗。总缓解率（ORR）为 91%，其中≥非常好的部分缓解（≥VGPR）率为 57%（包括 20%严格完全缓解/完全缓解[sCR/CR]率）。在一线患者中，ORR 为 94%，其中≥VGPR 率为 56%（包括 24%sCR/CR）。中位 CD34+阳性干细胞采集量为 10.67x10(6)/kg。34 名可评估反应的患者在 ASCT 后的 ORR 为 100%，其中≥VGPR 率为 76%（包括 53%sCR/CR）。在所有 44 名患者中，中位无进展生存期（PFS）为 27.4 个月。中位随访 25 个月后，中位总生存期（OS）尚未达到，2 年 OS 率为 82%。未接受 ASCT 和接受 ASCT 的患者在 PFS（27.4 个月 vs 23.5 个月）或 2 年生存率（80% vs 90%）方面均无显著差异。20 名患者（45%）发生周围神经病变，包括 4 名（9%）患者发生 3 级神经病变，1 名患者发生深静脉血栓形成。
BTD 作为适合 ASCT 的 MM 患者的诱导治疗，疗效高且耐受性好。有无 ASCT 巩固治疗的长期结果似乎相似。
