硼替佐米联合苯达莫司汀和泼尼松一线治疗多发性骨髓瘤患者中游离轻链迅速下降对预后的影响。
Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV).
机构信息
Hematology and Cell Therapy, Medical Clinic and Policlinic 1, University Hospital Leipzig, Liebigstraße 22, 04103, Leipzig, Germany.
Hospital Torgau, Christianistraße 1, 04860, Torgau, Germany.
出版信息
J Cancer Res Clin Oncol. 2021 Aug;147(8):2349-2359. doi: 10.1007/s00432-020-03504-3. Epub 2021 Jan 12.
INTRODUCTION
Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value.
METHODS
This retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV).
RESULTS
After a median number of two (range 1-5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05).
CONCLUSION
These results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.
简介
新诊断的多发性骨髓瘤（MM）患者几乎都存在轻链受累。由于游离轻链（FLC）半衰期较短，其水平的快速降低具有潜在的预后价值。
方法
本回顾性分析纳入了 92 例接受硼替佐米、泼尼松和苯达莫司汀（BPV）治疗的新诊断 MM 患者。
结果
中位接受 2 个（范围 1-5）BPV 周期后，大多数患者（n=86；93%）达到了非常好的完全缓解（sCR，n=21）、完全缓解（CR，n=1）、严格意义的完全缓解（nCR，n=25）、非常好的部分缓解（VGPR，n=20）或部分缓解（PR，n=19）。48 个月时的无进展生存期（PFS）和总生存期（OS）分别为 39%和 67%。基线时，92 例患者中有 79 例（86%）的游离轻链（iFLC）水平高于上限标准，且受累与未受累游离轻链的比值≥8。在这些患者的亚组分析中，我们评估了前两个 BPV 周期中 iFLC 早期降低的预后意义。在 69 例患者中，有 31 例在第 1 个周期第 8 天观察到 iFLC 降低≥50%。与 38 例 iFLC 降低较低的患者（中位 PFS 20 个月）相比，这些患者的中位 PFS 显著更长（49 个月；p=0.002）。相比之下，OS 无显著差异，48 个月生存率分别为 77%和 69%（p＞0.05）。
结论
这些结果表明，在接受 BPV 治疗的新诊断 MM 患者中，第 8 天 iFLC 的快速下降是早期预后标志物。
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