Yıkılmaz Aysun Şentürk, Akinci Sema, Bakanay Şule Mine, Dilek İmdat
Department of Hematology, Yıldırım Beyazıt University, Ankara 06010, Turkey.
Department of Hematology, Ataturk Training And Research Hospital, Ankara 06010, Turkey.
Int J Hematol Oncol Stem Cell Res. 2020 Oct 1;14(4):248-256. doi: 10.18502/ijhoscr.v14i4.4481.
Complete response (CR) and very good partial response (VGPR) are targeted with pre-ASCT induction regimens in patients by diagnosed multiple myeloma (MM), who are candidates for ASCT. In this study, it was aimed to compare the response and survival evaluations of cases who underwent induction treatment by vincristine-doxorubicin-dexamethasone (VAD) protocol versus bortezomib containing regimens. The data of 96 ASCT eligible patients, retrospectively analyzed. P value> 0.05 was considered statistically significant. While 66 cases had received bortezomib containing regimens as induction regimen, 30 cases had received VAD protocol. The total survival was 91.3 (st.s 6) months and 43 (st.s 7.9) months, respectively, when we compared the cases without ASCT and with ASCT (p = 0.001). The OS of patients who underwent ASCT after reaching at least VGPR was longer than the underwent ASCT without reaching VGPR (p=0.019). Post-ASCT PFS (p=0.717) and OS (p = 0.126) analyzes were performed in 74 cases undergoing ASCT treatment, there was no significant statistical difference when patients with treated by VAD protochol and treated by bortezomib containing regimens as pre-ASCT induction regimens was compared to each other. Whatever the type of induction regimen is, the level of response achieved before ASCT is important. The survival of the myeloma patients are much more influenced with HDT-ASCT as well as post-transplantation strategies to keep the patients in remission. Even though it is outdated, we think that the VAD protocol may be an option in patients who are not responding with the new generation of agents in the following days.
完全缓解（CR）和非常好的部分缓解（VGPR）是确诊为多发性骨髓瘤（MM）且适合进行自体造血干细胞移植（ASCT）的患者在ASCT前诱导方案的治疗目标。本研究旨在比较接受长春新碱-阿霉素-地塞米松（VAD）方案诱导治疗的病例与含硼替佐米方案诱导治疗的病例的缓解情况和生存评估。对96例符合ASCT条件的患者的数据进行了回顾性分析。P值>0.05被认为具有统计学意义。66例患者接受含硼替佐米方案作为诱导方案，30例患者接受VAD方案。在比较未进行ASCT和进行ASCT的病例时，总生存期分别为91.3（标准差6）个月和43（标准差7.9）个月（p = 0.001）。达到至少VGPR后接受ASCT的患者的总生存期长于未达到VGPR而接受ASCT的患者（p = 0.019）。对74例接受ASCT治疗的患者进行了ASCT后无进展生存期（p = 0.717）和总生存期（p = 0.126）分析，比较接受VAD方案和接受含硼替佐米方案作为ASCT前诱导方案治疗的患者时，没有显著的统计学差异。无论诱导方案的类型如何，ASCT前达到的缓解水平都很重要。骨髓瘤患者的生存更多地受到大剂量化疗联合自体造血干细胞移植（HDT-ASCT）以及使患者维持缓解的移植后策略的影响。尽管VAD方案已过时，但我们认为对于未来对新一代药物无反应的患者，它可能是一种选择。
