Saraceni Megan M, Scott Emma, Maziarz Richard T, Siegel Matthew B, Bassale Solange, Jiing Susie, Medvedova Eva
Department of Pharmacy Services, Oregon Health and Science University, Portland, OR.
Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR.
Clin Lymphoma Myeloma Leuk. 2018 Jan;18(1):e77-e84. doi: 10.1016/j.clml.2017.10.008. Epub 2017 Nov 2.
Multiple myeloma (MM) is an incurable plasma cell malignancy, in which aggressive relapses might require salvage cytotoxic infusional chemotherapy. Several clinical trials that reported the efficacy of bortezomib led to institutional practice changes in which vincristine was replaced with bortezomib in the modified hyperCVAD regimen, creating a new treatment regimen, named "bortezomib-hyperCAD."
We retrospectively describe the effectiveness and tolerability of 2 chemotherapy regimens among 33 patients with relapsed and/or refractory MM. Patients who received ≥ 1 cycle of modified hyperCVAD or bortezomib-hyperCAD between 2011 and 2015 were assessed.
The median number of cycles administered in each arm was 2. The overall response rate was 40% (6 partial responses) in the modified hyperCVAD group and 44.4% (1 complete response, 1 very good partial response, and 6 partial responses) in the bortezomib-hyperCAD group (Fisher exact P = .80). Median progression-free survival (PFS) and median overall survival (OS) for patients in the modified hyperCVAD group was 6.3 months and 11.1 months, respectively. This was comparable with patients in the bortezomib-hyperCAD group, who had a median PFS of 6.6 months and a median OS of 13.8 months (log rank P = .54 and .66, respectively). There was no statistically significant association between treatment arm and febrile neutropenia, emergency department visits, hospitalizations, or peripheral neuropathy (all Fisher exact P values > .05).
Overall effectiveness and tolerability outcomes were similar between modified hyperCVAD and bortezomib-hyperCAD, with both regimens showing an impressive response rate among refractory and heavily pretreated patients with relapsed MM.
多发性骨髓瘤（MM）是一种无法治愈的浆细胞恶性肿瘤，其侵袭性复发可能需要挽救性细胞毒性输注化疗。多项报告硼替佐米疗效的临床试验导致了机构实践的改变，即在改良的hyperCVAD方案中用硼替佐米替代长春新碱，从而产生了一种新的治疗方案，称为“硼替佐米-hyperCAD”。
我们回顾性描述了33例复发和/或难治性MM患者中2种化疗方案的有效性和耐受性。评估了2011年至2015年间接受≥1个周期改良hyperCVAD或硼替佐米-hyperCAD治疗的患者。
每组给药的中位周期数为2。改良hyperCVAD组的总缓解率为40%（6例部分缓解），硼替佐米-hyperCAD组为44.4%（1例完全缓解、1例非常好的部分缓解和6例部分缓解）（Fisher精确检验P = 0.80）。改良hyperCVAD组患者的中位无进展生存期（PFS）和中位总生存期（OS）分别为6.3个月和11.1个月。这与硼替佐米-hyperCAD组患者相当，该组患者的中位PFS为6.6个月，中位OS为13.8个月（对数秩检验P分别为0.54和0.66）。治疗组与发热性中性粒细胞减少、急诊科就诊、住院或周围神经病变之间无统计学显著关联（所有Fisher精确检验P值>0.05）。
改良hyperCVAD和硼替佐米-hyperCAD的总体有效性和耐受性结果相似，两种方案在难治性和经过大量预处理的复发MM患者中均显示出令人印象深刻的缓解率。
