Kim Min Kyoung, Kim Kihyun, Min Chang-Ki, Kwak Jae-Yong, Bae Sang-Byung, Yoon Sung-Soo, Lee Je-Jung, Kim Ki Hwan, Nam Seung-Hyun, Mun Yeung-Chul, Kim Hyo Jung, Bae Sung Hwa, Shin Ho-Jin, Lee Jung-Hee, Park Joon Seong, Jeong Seong Hyun, Lee Mark Hong, Kim Yang-Soo, Lee Ho Sup, Park Keon Woo, Lee Won-Sik, Lee Sang Min, Lee Jeong-Ok, Hyun Myung Soo, Jo Deog Yeon, Lim Sung-Nam, Lee Jae Hoon, Cho Do-Yeun, Do Young Rok, Kim Jeong-A, Park Seong Kyu, Kim Jin Seok, Kim Soo-Jeong, Kim Hawk, Yi Hyeon Gyu, Moon Joon Ho, Choi Chul Won, Kim Sung-Hyun, Joo Young-Don, Kim Hoon-Gu, Kim Byung Soo, Park Moo-Rim, Song Moo-Kon, Kim Su-Youn
Department of Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Oncotarget. 2017 Jun 6;8(23):37605-37618. doi: 10.18632/oncotarget.16790.
Bortezomib-melphalan-prednisone (VMP) showed superior efficacy versus MP as first-line treatment for transplantation-ineligible multiple myeloma (MM). This study investigated the efficacy of VMP for Korean patients with MM.Overall, 177 MM patients received 9 cycles of VMP in this prospective, multicenter, observational study. The primary endpoint was 2-year progression-free survival (PFS).Thirty-nine (22%) patients were aged ≥ 75 years and 83 (47.4%) patients had International Staging System stage III. A median of 5 cycles were delivered. Overall response rate (ORR) was 72.9%, and complete response (CR) rate was 20.3%. With a median follow-up of 11.9 months, median PFS was 17 months. The 2-year PFS and overall survival (OS) rates were 29.2% and 80.0%, respectively. Median OS was not reached. PFS was significantly different depending on performance status (Eastern Cooperative Oncology Group < 2 vs. ≥ 2; p = 0.0002), β2-microglobulin level (< 5.5 vs. ≥ 5.5 mg/L; p = 0.0481), and cumulative dose of bortezomib (< 35.1 vs. ≥ 35.1 mg/m2; p < 0001). The common adverse events (AEs) were in line with the well-known toxicity profiles associated with VMP.In conclusion, VMP is a feasible and effective front-line treatment for transplant-ineligible older patients with MM in Korea. Continuing therapy with prompt adjustment of treatment according to AEs may be important to improve outcomes of elderly patients.
硼替佐米-美法仑-泼尼松（VMP）作为一线治疗方案，在不适宜进行移植的多发性骨髓瘤（MM）患者中显示出优于美法仑-泼尼松（MP）的疗效。本研究调查了VMP方案对韩国MM患者的疗效。
总体而言，在这项前瞻性、多中心、观察性研究中，177例MM患者接受了9个周期的VMP治疗。主要终点为2年无进展生存期（PFS）。
39例（22%）患者年龄≥75岁，83例（47.4%）患者国际分期系统为III期。中位给药周期数为5个周期。总缓解率（ORR）为72.9%，完全缓解（CR）率为20.3%。中位随访11.9个月时，中位PFS为17个月。2年PFS率和总生存期（OS）率分别为29.2%和80.0%。中位OS未达到。PFS根据体能状态（东部肿瘤协作组<2 vs.≥2；p = 0.0002）、β2-微球蛋白水平（<5.5 vs.≥5.5 mg/L；p = 0.0481）以及硼替佐米累积剂量（<35.1 vs.≥35.1 mg/m2；p < 0.0001）存在显著差异。常见不良事件（AE）与VMP已知的毒性特征相符。
总之，VMP是韩国不适宜进行移植的老年MM患者可行且有效的一线治疗方案。根据AE及时调整治疗方案持续治疗，对于改善老年患者的预后可能很重要。
