Reece Donna E, Trieu Young, Masih-Khan Esther, Atenafu Eshetu G, Chen Christine, Prica Anca, Tiedemann Rodger, Trudel Suzanne, Kukreti Vishal
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Clin Lymphoma Myeloma Leuk. 2016 Jul;16(7):387-94. doi: 10.1016/j.clml.2016.04.012. Epub 2016 May 10.
Cyclophosphamide, bortezomib, and prednisone (CyBorP) is a highly effective, well-tolerated regimen in relapsed/refractory multiple myeloma. CyBorP, originally developed at our center to include weekly bortezomib (Bor) and alternate-day prednisone (P), was recently modified so that weekly dexamethasone (D) replaced prednisone.
To assess the effectiveness and tolerability of CyBorP/D in real-world practice, we identified 96 relapsed/refractory patients who received ≥ 1 28-day cycle of CyBorP/D, consisting of cyclophosphamide 300 mg/m(2) (days 1, 8, 15, and 22), Bor 1.0 to 1.5 mg/m(2) (days 1, 8, and 15), and either P 50 to 100 mg on alternate days or D 20 to 40 mg weekly between 2007 and 2013.
Sixty-six (69%) patients achieved ≥ partial response: 16 with clinical complete response and 25 with very good partial response; 22 others had stable disease. Progression-free and overall survival for all patients were 16.2 months (95% confidence interval [CI], 7.7-20.1 months) and 26.3 months (95% CI, 21.6-81.2 months), respectively. Although 26 patients had prior Bor exposure, there was no difference in progression-free or overall survival versus Bor-naive patients.
Toxicities with CyBorP/D were generally mild and manageable. New onset peripheral neuropathy was seen in 13 cases; 9 of 26 patients with pre-existing peripheral neuropathy developed worsening symptoms. No second primary malignancies were observed.
环磷酰胺、硼替佐米和泼尼松（CyBorP）是复发/难治性多发性骨髓瘤中一种高效且耐受性良好的治疗方案。CyBorP最初由我们中心研发，包括每周一次的硼替佐米（Bor）和隔日一次的泼尼松（P），最近进行了修改，用每周一次的地塞米松（D）替代了泼尼松。
为了评估CyBorP/D在实际临床中的有效性和耐受性，我们纳入了96例复发/难治性患者，这些患者接受了≥1个28天周期的CyBorP/D治疗，具体方案为环磷酰胺300mg/m²（第1、8、15和22天），Bor剂量为1.0至1.5mg/m²（第1、8和15天），2007年至2013年间，患者接受隔日50至100mg的P或每周20至40mg的D治疗。
66例（69%）患者达到≥部分缓解：16例获得临床完全缓解，25例获得非常好的部分缓解；另外22例病情稳定。所有患者的无进展生存期和总生存期分别为16.2个月（95%置信区间[CI]，7.7 - 20.1个月）和26.3个月（95%CI，21.6 - 81.2个月）。虽然26例患者既往曾接受过Bor治疗，但与未接受过Bor治疗的患者相比，无进展生存期或总生存期并无差异。
CyBorP/D的毒性一般较轻且易于控制。13例出现新发周围神经病变；26例既往有周围神经病变的患者中有9例症状加重。未观察到第二原发性恶性肿瘤。
