Chen Liang, Li Zhendong, Li Shanshan, Fu Weijun, Li Rong
Department of Hematology, Navy Medical Center of PLA, Shanghai, China.
J Cancer. 2020 Feb 19;11(9):2639-2644. doi: 10.7150/jca.40711. eCollection 2020.
Multiple myeloma (MM) is a heterogeneous disease characterized by chromosomal translocation, deletion, and amplification in plasma cells, resulting in a huge heterogeneity in its outcomes. Of all these cytogenetic abnormalities, Amp1q21 is most commonly detected, which is always associated with significantly shorter progression-free survival (PFS) and overall survival (OS) than normal 1q copy number status. In the era of novel agents such as bortezomib, ixazomib, lenalidomide, a head-to-head comparison of all these agents is still absent, especially in the patients with Amp1q21 alone. So, aiming to explore the optimum therapy to the patients with Amp1q21 only, we conduct this study. We searched the PubMed, the Cochrane Library, PMC and the Embase databases, and we selected all the randomized controlled trials (RCTs) in English about MM with Amp1q21 up to April, 2019. A total of 72 papers were full screened and finally 2 literatures can be included in our study. Of the two studies, the one is about IRd (ixazomib, lenalidomide, dexamethasone) vs. placebo-Rd (HR, 0.781; 95% CI, 0.492-1.240), another is about VAD (vincristine, adriamycin, dexamethasone) vs. PAD (bortezomib, adriamycin, dexamethasone) (3-year survival rate: 59% vs. 83%, p=0.016). From this review, MM patients with Amp1q21 may somewhat benefit from ixazomib but the evidence is still stuffless. What's more, a head-to-head comparison between ixazomib and other agents among MM patients with Amp1q21 is also absent. So, we sincerely expect this review can attract some attention for the therapy of this special part of patients. This study was registered in https://www.crd.york.ac.uk/prospero/#recordDetails.
多发性骨髓瘤（MM）是一种异质性疾病，其特征为浆细胞中的染色体易位、缺失和扩增，导致其预后存在巨大的异质性。在所有这些细胞遗传学异常中，1q21扩增（Amp1q21）最为常见，与正常1q拷贝数状态相比，它总是与显著缩短的无进展生存期（PFS）和总生存期（OS）相关。在硼替佐米、伊沙佐米、来那度胺等新型药物的时代，所有这些药物之间仍缺乏直接比较，尤其是在仅存在Amp1q21的患者中。因此，为了探索仅针对Amp1q21患者的最佳治疗方法，我们开展了本研究。我们检索了PubMed、Cochrane图书馆、PMC和Embase数据库，并选择了截至2019年4月所有关于伴有Amp1q21的MM的英文随机对照试验（RCT）。共对72篇论文进行了全面筛选，最终2篇文献可纳入我们的研究。在这两项研究中，一项是关于IRd（伊沙佐米、来那度胺、地塞米松）对比安慰剂-Rd（HR，0.781；95%CI，0.492-1.240），另一项是关于VAD（长春新碱、阿霉素、地塞米松）对比PAD（硼替佐米、阿霉素、地塞米松）（3年生存率：59%对83%，p=0.016）。通过本综述，伴有Amp1q21的MM患者可能在一定程度上从伊沙佐米中获益，但证据仍不充分。此外，在伴有Amp1q21的MM患者中，伊沙佐米与其他药物之间也缺乏直接比较。因此，我们真诚地希望本综述能引起对这部分特殊患者治疗的一些关注。本研究已在https://www.crd.york.ac.uk/prospero/#recordDetails注册。
