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复发多发性骨髓瘤患者皮下硼替佐米的再治疗和延长治疗:一项随机、对照、III 期研究。

Retreatment and prolonged therapy with subcutaneous bortezomib in patients with relapsed multiple myeloma: A randomized, controlled, phase III study.

机构信息

Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece.

Clinical Hematology, IRCCS AOU San Martino-IST, Genova, Italy.

出版信息

Eur J Haematol. 2018 Jan;100(1):10-19. doi: 10.1111/ejh.12937. Epub 2017 Oct 30.

Abstract

OBJECTIVES

This randomized, international, multicenter, open-label phase III study investigated the effects of experimental retreatment with subcutaneous bortezomib plus dexamethasone (VD) followed by prolonged bortezomib therapy vs standard VD retreatment in patients with relapsed/refractory multiple myeloma.

METHODS

Patients were randomized (2:1) to receive either experimental (n = 53) or standard (n = 27) retreatment, stratified by the number of prior therapy lines.

RESULTS

The study was terminated prematurely with insufficient enrollment to adequately compare the retreatment therapies; results should be considered descriptive. After a median follow-up of 21.2 and 20.0 months in the experimental and standard arms, respectively, the median progression-free survival (primary endpoint) was 7.2 months (95% confidence interval 5.7-9.0) vs 7.8 months (4.9-11.7). The overall response rate was 66% and 52% for experimental and standard retreatment regimens, respectively. Thrombocytopenia was the most common and most differentially observed grade ≥3 adverse event (experimental: 9% vs standard: 22%). Any-grade peripheral neuropathies (including peripheral sensory neuropathies) were reported in 23% vs 37% of patients.

CONCLUSIONS

This study showed no significant benefit with experimental vs standard VD retreatment therapy. Further investigations are required to determine whether the experimental retreatment regimen is a suitable alternative to the current standard retreatment regimen.

摘要

目的

这项随机、国际性、多中心、开放性 III 期研究旨在调查皮下硼替佐米联合地塞米松(VD)实验性再治疗后再延长硼替佐米治疗与复发/难治性多发性骨髓瘤患者标准 VD 再治疗的效果。

方法

根据既往治疗线数,将患者(2:1)随机分配至实验组(n=53)或标准组(n=27)接受再治疗。

结果

由于入组不足,研究提前终止,无法充分比较再治疗方案;结果应被视为描述性的。在实验组和标准组的中位随访时间分别为 21.2 和 20.0 个月后,中位无进展生存期(主要终点)分别为 7.2 个月(95%置信区间为 5.7-9.0)和 7.8 个月(4.9-11.7)。实验组和标准组的总缓解率分别为 66%和 52%。血小板减少症是最常见和差异最大的≥3 级不良事件(实验组:9% vs 标准组:22%)。实验组和标准组分别有 23%和 37%的患者报告有任何级别周围神经病变(包括周围感觉神经病变)。

结论

与标准 VD 再治疗方案相比,实验组方案并未显示出显著获益。需要进一步研究以确定实验性再治疗方案是否是当前标准再治疗方案的合适替代方案。

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