Chakraborty R, Muchtar E, Kumar S, Buadi F K, Dingli D, Dispenzieri A, Hayman S R, Hogan W J, Kapoor P, Lacy M Q, Leung N, Gertz M A
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Hospitalist Services, Essentia Health-St. Joseph's Medical Center, Brainerd, MN, USA.
Bone Marrow Transplant. 2017 Jan;52(1):34-40. doi: 10.1038/bmt.2016.214. Epub 2016 Aug 22.
We compared overall survival (OS) of 1017 patients with newly diagnosed multiple myeloma (MM) who were treated with different novel agent-based induction regimens and who underwent early autologous stem cell transplant (ASCT). Subgroups were defined by type of induction therapy: cyclophosphamide-bortezomib-dexamethasone (CyBorD; n=193), bortezomib-dexamethasone (Vd; n=64), lenalidomide-dexamethasone (Rd; n=251), bortezomib-lenalidomide-dexamethasone (VRd; n=126), thalidomide-dexamethasone (Td; n=155) and vincristine-doxorubicin-dexamethasone or dexamethasone alone (VAD/Dex; n=228). The median follow-up of the surviving patients was 66.7 months. The 5-year OS rates with CyBorD, Vd, Rd, VRd, Td and VAD/Dex were 79.2%, 72.3%, 79.2%, 79.0%, 57.4% and 63.4%, respectively (log-rank, P<0.001). In a multivariate analysis, after controlling for important patient and disease variables, VRd had a superior OS compared with CyBorD (hazard ratio (HR), 0.32; 95% confidence interval (CI), 0.10-0.88; P=0.03) and Vd (HR, 0.16; 95% CI, 0.04-0.52; P=0.002). In conclusion, our study demonstrates that among patients completing induction therapy and continuing to early transplant, VRd induction leads to improved OS compared with CyBorD and Vd regimens.
我们比较了1017例新诊断的多发性骨髓瘤（MM）患者的总生存期（OS），这些患者接受了不同的基于新型药物的诱导方案治疗，并接受了早期自体干细胞移植（ASCT）。亚组根据诱导治疗类型定义：环磷酰胺-硼替佐米-地塞米松（CyBorD；n = 193）、硼替佐米-地塞米松（Vd；n = 64）、来那度胺-地塞米松（Rd；n = 251）、硼替佐米-来那度胺-地塞米松（VRd；n = 126）、沙利度胺-地塞米松（Td；n = 155）以及长春新碱-阿霉素-地塞米松或仅用地塞米松（VAD/Dex；n = 228）。存活患者的中位随访时间为66.7个月。CyBorD、Vd、Rd、VRd、Td和VAD/Dex的5年总生存率分别为79.2%、72.3%、79.2%、79.0%、57.4%和63.4%（对数秩检验，P<0.001）。在多变量分析中，在控制了重要的患者和疾病变量后，VRd的总生存期优于CyBorD（风险比（HR），0.32；95%置信区间（CI），0.10 - 0.88；P = 0.03）和Vd（HR，0.16；95%CI，0.04 - 0.52；P = 0.002）。总之，我们的研究表明，在完成诱导治疗并继续进行早期移植的患者中，与CyBorD和Vd方案相比，VRd诱导可改善总生存期。
