Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
Division of Nephrology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
Blood Cancer J. 2018 Nov 8;8(11):106. doi: 10.1038/s41408-018-0147-7.
We retrospectively reviewed all patients (n = 243) receiving bortezomib, lenalidomide, and dexamethasone (VRd) induction followed by autologous stem cell transplantation (ASCT) for multiple myeloma at the Mayo Clinic between January 2010 and April of 2017. Median age was 61 (interquartile range, 55-67) with 62% of patients being male. High-risk cytogenetic abnormalities (HRA) were present in 34% of patients. A total of 166 (68%) patients received some form of maintenance/other therapy post transplant (no maintenance (NM, n = 77), lenalidomide maintenance (LM, n = 108), bortezomib maintenance (BM, n = 39), and other therapy (OT, n = 19)). Overall response rate at day 100 post ASCT was 99% (CR 42%) with CR rate increasing to 62% at time of best response post transplant. Two year and 5 year overall survival rates were 90% and 67%, respectively, with an estimated median overall survival (OS) and progression-free survival (PFS) of 96 and 28 months, respectively. HRA was associated with a worse OS but not PFS (median OS: not reached for standard risk vs 60 months for HRA, P = 0.0006; median PFS: 27 months for standard risk vs 22 months for HRA, P = 0.70). The combination of VRd followed by ASCT is a highly effective regimen producing deep and durable responses in many patients.
我们回顾性分析了 2010 年 1 月至 2017 年 4 月期间在梅奥诊所接受硼替佐米、来那度胺和地塞米松（VRd）诱导治疗后接受自体干细胞移植（ASCT）的 243 例多发性骨髓瘤患者。中位年龄为 61 岁（四分位间距，55-67），62%的患者为男性。34%的患者存在高危细胞遗传学异常（HRA）。共有 166 例（68%）患者在移植后接受了某种形式的维持/其他治疗（无维持（NM，n=77）、来那度胺维持（LM，n=108）、硼替佐米维持（BM，n=39）和其他治疗（OT，n=19））。ASCT 后第 100 天的总体缓解率为 99%（完全缓解（CR）42%），CR 率在移植后最佳反应时增加至 62%。2 年和 5 年总生存率分别为 90%和 67%，估计中位总生存期（OS）和无进展生存期（PFS）分别为 96 个月和 28 个月。HRA 与较差的 OS 相关，但与 PFS 无关（中位 OS：标准风险为未达到，HRA 为 60 个月，P=0.0006；中位 PFS：标准风险为 27 个月，HRA 为 22 个月，P=0.70）。VRd 联合 ASCT 是一种非常有效的方案，可使许多患者产生深度和持久的缓解。
