Holmberg Leona A, Becker Pamela S, Bensinger William
Clinical Research Division, Fred Hutchinson Cancer Research Center, and Department of Medicine, University of Washington, Seattle, WA, USA.
Acta Haematol. 2017;137(3):123-131. doi: 10.1159/000455937. Epub 2017 Mar 30.
In multiple myeloma (MM), relapse is a problem after autologous hematopoietic stem cell transplantation (ASCT). In the nontransplant setting, thalidomide/dexamethasone/clarithromycin (BLT-D) and lenalidomide/dexamethasone/clarithromycin (BiRd) achieve responses with acceptable toxicity. Both regimens are reasonable objects of study in the post-ASCT setting.
We report on BLT-D and BiRd given post-ASCT. Studies were conducted consecutively. After recovery from ASCT, therapy was started. All 3 drugs were given for 1 year, and then immunomodulatory drugs alone were given as long as tolerated or until disease progression.
For BLT-D, the most common toxicity was peripheral neuropathy (PN). For BiRd, infection, PN, and neutropenia were the most common adverse events. BiRd was associated with a higher frequency of secondary cancers. The median follow-up for BLT-D was 10.2 years (range 8.6-10.7) and for BiRd it was 7.5 years (range 6.4-8.4). After BLT-D, 18 patients (67%) were alive and 10 (37%) were alive without disease progression, and after BiRd, 18 patients (58%) were alive and 10 (32%) were alive without disease progression.
BLT-D and BiRd can be given post-ASCT with different toxicity profiles and comparable disease-free and overall survival rates. A randomized study comparing these regimens to single-agent lenalidomide is needed to determine which approach is superior. Key Message: Relapse of MM is a major problem after ASCT. Strategies are needed post-ASCT to improve outcomes. In the nontransplant setting, thalidomide or lenalidomide/dexamethasone/clarithromycin treat MM with acceptable toxicity. We, thus, studied both regimens post- ASCT. They can be given with different toxicity profiles and result in good disease control.
在多发性骨髓瘤（MM）中，自体造血干细胞移植（ASCT）后复发是一个问题。在非移植环境中，沙利度胺/地塞米松/克拉霉素（BLT-D）和来那度胺/地塞米松/克拉霉素（BiRd）可产生疗效且毒性可接受。这两种方案都是ASCT后合理的研究对象。
我们报告了ASCT后给予BLT-D和BiRd的情况。研究连续进行。ASCT恢复后开始治疗。所有三种药物均给药1年，然后只要耐受或直至疾病进展，仅给予免疫调节药物。
对于BLT-D，最常见的毒性是周围神经病变（PN）。对于BiRd，感染、PN和中性粒细胞减少是最常见的不良事件。BiRd与继发性癌症的发生率较高相关。BLT-D的中位随访时间为10.2年（范围8.6 - 10.7年），BiRd为7.5年（范围6.4 - 8.4年）。接受BLT-D治疗后，18例患者（67%）存活，10例（37%）无疾病进展存活；接受BiRd治疗后，18例患者（58%）存活，10例（32%）无疾病进展存活。
ASCT后可给予BLT-D和BiRd，它们具有不同的毒性特征以及相当的无病生存率和总生存率。需要进行一项将这些方案与单药来那度胺进行比较的随机研究，以确定哪种方法更优。关键信息：MM在ASCT后复发是一个主要问题。ASCT后需要采取策略来改善结局。在非移植环境中，沙利度胺或来那度胺/地塞米松/克拉霉素可治疗MM且毒性可接受。因此，我们研究了这两种方案在ASCT后的情况。它们可产生不同的毒性特征并实现良好的疾病控制。
