Areethamsirikul N, Masih-Khan E, Chu C-M, Jimenez-Zepeda V, Reece D E, Trudel S, Kukreti V, Tiedemann R, Chen C
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Bone Marrow Transplant. 2015 Mar;50(3):375-9. doi: 10.1038/bmt.2014.288. Epub 2015 Jan 19.
Cyclophosphamide, bortezomib and dexamethasone (CyBorD) is a highly active three-drug induction regimen for untreated transplant-eligible multiple myeloma patients. Although CyBorD has been evaluated only in the phase 2 setting in a limited number of patients, its high efficacy and ease of administration have led to its widespread use. Given that clinical trial efficacy can overestimate real-life effectiveness, we reviewed our institutional experience with 109 newly diagnosed patients who were treated with CyBorD in a non-clinical trial setting. After a median of four cycles, overall response rate (ORR) and very good partial response rate or better (⩾VGPR) were 95 and 66%, respectively, comparable to phase 2 studies of CyBorD and other three/four-drug induction regimens. All patients subsequently underwent successful stem cell collection and upgraded responses to ORR 98% and ⩾VGPR 79% post transplant. At a median follow-up of 19.8 months after diagnosis, the 2-year OS probability was 95.3% (95%CI: 89-98). The presence of concurrent plasmacytoma at diagnosis was the only prognostic factor predicting poorer survival (HR=5.56; 95%CI: 0.92-33.74; P=0.03). CyBorD was well-tolerated, with no severe peripheral neuropathy and minimal hematologic toxicity. Therefore, CyBorD is a convenient, well-tolerated, highly effective induction regimen in preparation for autologous SCT in real-life clinical practice.
环磷酰胺、硼替佐米和地塞米松（CyBorD）是一种用于未治疗的适合移植的多发性骨髓瘤患者的高效三药诱导方案。尽管CyBorD仅在2期试验中对有限数量的患者进行了评估，但其高疗效和易于给药导致其广泛应用。鉴于临床试验疗效可能高估实际疗效，我们回顾了我们机构对109例新诊断患者在非临床试验环境中接受CyBorD治疗的经验。经过中位4个周期的治疗，总缓解率（ORR）和非常好的部分缓解率或更好（⩾VGPR）分别为95%和66%，与CyBorD及其他三药/四药诱导方案的2期研究结果相当。所有患者随后均成功进行了干细胞采集，移植后ORR提高至98%，⩾VGPR提高至79%。在诊断后中位随访19.8个月时，2年总生存率概率为95.3%（95%CI：89-98）。诊断时并发浆细胞瘤是预测生存较差的唯一预后因素（HR=5.56；95%CI：0.92-33.74；P=0.03）。CyBorD耐受性良好，无严重周围神经病变，血液学毒性极小。因此，在实际临床实践中，CyBorD是一种方便、耐受性良好、高效的诱导方案，可用于自体干细胞移植的准备。
