Liu Jinghua, Yang Hui, Liang Xiaochan, Wang Yuxin, Hou Jian, Liu Yanqin, Wang Jigang, Zhou Fan
Department of Hematology, The General Hospital of Shenyang Military, Shenyang, China.
Department of Clinical Medicine, Shenyang Pharmaceutical University, Shenyang, China.
Oncotarget. 2017 Jun 27;8(37):62435-62444. doi: 10.18632/oncotarget.18722. eCollection 2017 Sep 22.
We analyzed the treatment of newly diagnosed and relapsed/refractory multiple myeloma (NDMM/RRMM) patients with del(17p). Thirteen prospective studies that evaluated 3,187 MM patients, including 685with del(17p), were included in our meta-analysis. The incidence of del(17p) in NDMM and RRMM patients was similar (13% vs. 14%, respectively, = 0.64, = 94%). The overall response rate (ORR) to new agents was 40.5% and 67.1%, respectively, in RRMM patients with or without del(17p) ( 0.1, = 63.9%). NDMM patients with del(17p) treated with PAD (bortezomib, adriamycin, and dexamethasone) induction therapy followed by bortezomib maintenance therapy had higher progression-free survival (PFS) (25.7 vs. 12-14.6 months) and overall survival (OS) (62% vs. 8% at 36 months) than those treated with PD (bortezomib and dexamethasone) or VAD (vincristine, adriamycin, and dexamethasone). PFS among RRMM patients with del(17p) treated with D (single-agent dexamethasone), Rd/VRd (lenalidomide and dexamethasone/bortezomib and Rd), KRd (carfilzomib and Rd), IRd (ixazomib and Rd), ERd (elotuzumab and Rd), or P+D (pomalidomide and dexamethasone) was 1.1, 2-14.9, 24.5, 15.7, 21.2, and 4.6-7.3 months, respectively. The OS of patients treated with D or K (single-agent carfilzomib), Rd/VRd, ERd, or P+D was 7.7, 7, 4.7-36.4, > 42.3, and 12-12.6 months, respectively. PFS among RRMM patients without del(17p) treated with D, Rd/VRd, ERd, or P+D was 2.3, 8.2-14.8, 18.5, and 4.2 months, while OS was 9, 23-40.8, 42.3, and 14 months, respectively. Thus bortezomib maintenance therapy improves the prognosis of NDMM patients with del(17p). Combined treatment with carfilzomib or elotuzumab and Rd, or pomalidomide with low-dose dexamethasone, improves the outcomes of RRMM patients with del(17p).
我们分析了伴有17p缺失的新诊断及复发/难治性多发性骨髓瘤（NDMM/RRMM）患者的治疗情况。我们的荟萃分析纳入了13项评估3187例MM患者的前瞻性研究，其中包括685例伴有17p缺失的患者。NDMM和RRMM患者中17p缺失的发生率相似（分别为13%和14%，P = 0.64，χ² = 94）。在伴有或不伴有17p缺失的RRMM患者中，对新型药物的总体缓解率（ORR）分别为40.5%和67.1%（P = 0.1，χ² = 63.9）。接受PAD（硼替佐米、阿霉素和地塞米松）诱导治疗后再接受硼替佐米维持治疗的伴有17p缺失的NDMM患者，其无进展生存期（PFS）（25.7个月对12 - 14.6个月）和总生存期（OS）（36个月时为62%对8%）高于接受PD（硼替佐米和地塞米松）或VAD（长春新碱、阿霉素和地塞米松）治疗的患者。接受D（单药地塞米松）、Rd/VRd（来那度胺和地塞米松/硼替佐米和Rd）、KRd（卡非佐米和Rd）、IRd（伊沙佐米和Rd）、ERd（埃罗妥珠单抗和Rd）或P + D（泊马度胺和地塞米松）治疗的伴有17p缺失RRMM患者的PFS分别为1.1、2 - 14.9、24.5、15.7、21.2和4.6 - 7.3个月。接受D或K（单药卡非佐米）、Rd/VRd、ERd或P + D治疗患者的OS分别为7.7、7、4.7 - 36.4、> 42.3和12 - 12.6个月。接受D、Rd/VRd、ERd或P + D治疗的不伴有17p缺失RRMM患者的PFS分别为2.3、8.2 - 14.8、18.5和4.2个月，而OS分别为9、23 - 40.8、42.3和14个月。因此，硼替佐米维持治疗可改善伴有17p缺失的NDMM患者的预后。卡非佐米或埃罗妥珠单抗与Rd联合治疗，或泊马度胺与低剂量地塞米松联合治疗，可改善伴有17p缺失的RRMM患者的治疗结局。
