含卡非佐米的联合方案作为多发性骨髓瘤的一线治疗：13项试验的荟萃分析

Carfilzomib-containing combinations as frontline therapy for multiple myeloma: A meta-analysis of 13 trials.

作者信息

Sheng Zhixin, Li Guifang, Li Bin, Liu Yanju, Wang Lida

机构信息

Department of Hematology, Weifang People's Hospital, Weifang, China.

Department of Occupational Disease, Weifang People's Hospital, Weifang, China.

出版信息

Eur J Haematol. 2017 Jun;98(6):601-607. doi: 10.1111/ejh.12877. Epub 2017 Apr 12.

DOI:10.1111/ejh.12877

PMID:28295593

Abstract

OBJECTIVE

To investigate the activity and safety of carfilzomib-containing combinations as frontline therapy for multiple myeloma.

METHODS

We searched published carfilzomib reports for newly diagnosed multiple myeloma.

RESULTS

Thirteen trials were identified, covering 704 subjects. Pooled analysis showed that carfilzomib combinations as frontline therapy for multiple myeloma attained an impressive at least complete response (≥CR) rate of 21%, at least very good partial response (≥VGPR) rate of 68%, overall response rate (ORR) of 94%. The ≥CR rates of 18% pre-SCT were increased to 43% of post-ASCT, and 64% of postconsolidation (P<.001). For those patients receiving carfilzomib therapy, response quality improved further over time (≥CR rates of 10% after 2nd cycle, 20% after 4th cycle, 43% after 8th cycle; ≥VGPR of 29% after 2nd cycle, 68% after 4th cycle, 88% after 8th cycle). ≥CR rates of 49% from CFZ-LEN-DEX triplet regimen were higher than 18% from CFZ-CYC-DEX triplet regimen and 21% from CFZ-THA-DEX triplet regimen (P=.03).

CONCLUSIONS

Carfilzomib combinations could produce clinical benefits in newly diagnosed patients with multiple myeloma. High-quality response rate could be further improved through ASCT, consolidation therapy, and more cycles of chemotherapy even in the era of carfilzomib. CFZ-LEN-DEX could be a good combination regimen.

摘要

目的

探讨含卡非佐米的联合方案作为多发性骨髓瘤一线治疗的活性和安全性。

方法

我们检索已发表的卡非佐米治疗新诊断多发性骨髓瘤的报告。

结果

共纳入13项试验，涵盖704名受试者。汇总分析显示，卡非佐米联合方案作为多发性骨髓瘤的一线治疗，至少完全缓解（≥CR）率达21%，令人印象深刻，至少非常好的部分缓解（≥VGPR）率为68%，总缓解率（ORR）为94%。移植前（pre-SCT）≥CR率为18%，自体干细胞移植后（post-ASCT）升至43%，巩固治疗后为64%（P<0.001）。对于接受卡非佐米治疗的患者，缓解质量随时间进一步改善（第2周期后≥CR率为10%，第4周期后为20%，第8周期后为43%；第2周期后≥VGPR为29%，第4周期后为68%，第8周期后为88%）。CFZ-LEN-DEX三联方案的≥CR率为49%，高于CFZ-CYC-DEX三联方案的18%和CFZ-THA-DEX三联方案的21%（P=0.03）。