Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2019 Nov;34(6):1333-1346. doi: 10.3904/kjim.2018.144. Epub 2018 Oct 26.
BACKGROUND/AIMS: Bortezomib plus melphalan-prednisone (VMP) is a standard treatment for multiple myeloma, particularly for patients who are ineligible for high-dose therapy. However, early discontinuation or treatment modification is often needed owing to adverse events. The aim of this study was to investigate the clinical outcomes of modifying the dose of melphalan-prednisone (MP) in patients receiving VMP.
We examined 67 patients who received a modified dose of MP, and 38 patients who received the regularly planned dose of MP. We then analyzed clinical differences between the groups.
Although there was no difference in the proportion of discontinuation due to adverse events between dose groups, more patients in the planned-dose group experienced earlier discontinuation in general. The overall response rate (ORR) was 81.0% and complete response (CR) rate was 30.5%. After a median 15.7 months of follow-up, the median progression-free survival (PFS) and overall survival (OS) were 25.0 and 47.8 months, respectively. There was no significant difference in the ORR, CR, PFS, and OS of the two dose groups. A median of four cycles were delivered, and the median cumulative bortezomib dose was 41.6 mg/m2 . The median PFS in patients with doses ≥ 41.6 mg/m2 was longer than that in patients with doses < 41.6 mg/m2 (35.1 months vs. 9.6 months). However, when MP was < 50% of the planned dose, PFS and OS were poor.
Modifying the dose of MP might be a feasible and effective therapeutic approach for multiple myeloma patients receiving VMP treatment.
背景/目的：硼替佐米联合马法兰-泼尼松（VMP）是多发性骨髓瘤的标准治疗方法，特别是对于不适合大剂量治疗的患者。然而，由于不良反应，通常需要提前停药或修改治疗方案。本研究旨在探讨 VMP 治疗患者中调整马法兰-泼尼松（MP）剂量的临床结局。
我们分析了 67 例接受 MP 剂量调整的患者和 38 例接受常规计划剂量 MP 的患者，然后分析了两组之间的临床差异。
尽管剂量组之间因不良反应而停药的比例没有差异，但计划剂量组的患者总体上更早停药。总缓解率（ORR）为 81.0%，完全缓解率（CR）为 30.5%。中位随访 15.7 个月后，中位无进展生存期（PFS）和总生存期（OS）分别为 25.0 和 47.8 个月。两组的 ORR、CR、PFS 和 OS 无显著差异。中位完成 4 个周期，中位累积硼替佐米剂量为 41.6mg/m2。剂量≥41.6mg/m2 的患者中位 PFS 长于剂量<41.6mg/m2 的患者（35.1 个月比 9.6 个月）。然而，当 MP 剂量<50%的计划剂量时，PFS 和 OS 较差。
对于接受 VMP 治疗的多发性骨髓瘤患者，调整 MP 剂量可能是一种可行且有效的治疗方法。
