The Armed Forces Capital Hospital, Seoul, South Korea.
Ann Hematol. 2012 Feb;91(2):249-56. doi: 10.1007/s00277-011-1298-9. Epub 2011 Jul 26.
Incorporation of novel agents has resulted in an improved response rate and reduced side effects in multiple myeloma. This has prompted combining novel agents in induction chemotherapy in patients with newly diagnosed multiple myeloma. Our patients received 2 cycles of vincristine, adriamycin, dexamethasone (VAD) and then 2 cycles of bortezomib, thalidomide, dexamethasone (VTD) chemotherapy as an induction treatment. Subsequently, autologous stem cell transplantation was performed, and bortezomib was administered as a consolidation therapy. Seventy-one patients were enrolled, and 65 were evaluable for response. After 2 cycles of VAD, the overall response rate was 69%. After VTD, the response rate improved to 97% with a complete response (CR) and near CR rate of 27%. Importantly, patients with cytogenetics, having poor prognostic features, all responded after VTD. Autologous stem cells were successfully collected in all 58 patients with a median CD34+ cell count of 7.12 × 10(6)/kg (range, 1.94-44.7 × 10(6)/kg), except in 1 patient (2%). After ASCT, 36 patients completed bortezomib maintenance with a combined CR and near CR rate approaching 75%. Median time to response was rapid (1.6 months). With a median follow-up duration of 52.7 months, the median TTP was 29.4 months and median OS was not reached. Toxicities proved manageable. In conclusion, sequential VAD and VTD induction therapy in patients with newly diagnosed multiple myeloma was active with manageable toxicity and excellent stem cell yields. The incorporation of bortezomib as a consolidation therapy improved the clinical outcome with the expense of rather frequent development of peripheral neuropathy.
新型药物的应用使多发性骨髓瘤的缓解率提高,副作用减少。这促使我们将新型药物联合应用于初诊多发性骨髓瘤患者的诱导化疗中。我们的患者接受了 2 个周期的长春新碱、阿霉素和地塞米松(VAD),然后接受了 2 个周期的硼替佐米、沙利度胺和地塞米松(VTD)化疗作为诱导治疗。随后进行了自体干细胞移植,并用硼替佐米进行巩固治疗。共有 71 例患者入组,其中 65 例可评估疗效。VAD 治疗 2 个周期后,总体缓解率为 69%。VTD 治疗后,缓解率提高至 97%,完全缓解(CR)和接近完全缓解(nCR)率为 27%。重要的是,所有具有不良预后特征的细胞遗传学患者在接受 VTD 治疗后均有反应。除 1 例患者(2%)外,所有 58 例患者均成功采集到自体干细胞,中位数 CD34+细胞计数为 7.12×106/kg(范围为 1.94-44.7×106/kg)。ASCT 后,36 例患者完成了硼替佐米维持治疗,总 CR 和 nCR 率接近 75%。中位起效时间较快(1.6 个月)。中位随访时间为 52.7 个月,中位无进展生存期(TTP)为 29.4 个月,中位总生存期(OS)尚未达到。毒性可控制。总之,新型 VAD 和 VTD 诱导治疗在初诊多发性骨髓瘤患者中具有活性,毒性可管理,干细胞产量高。硼替佐米作为巩固治疗药物的应用提高了临床疗效,但周围神经病变的发生率较高。
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