硼替佐米、来那度胺和地塞米松治疗新诊断的多发性骨髓瘤患者的疗效和预后
[Efficacy and prognosis of newly diagnosed multiple myeloma patients treated with bortezomib, lenalidomide and dexamethasone].
作者信息
Xu J Y, Yan W W, Fan H S, Liu J H, Du C X, Deng S H, Sui W W, Xu Y, Qiu L G, An G
机构信息
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin 300020, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2022 Aug 16;102(30):2338-2344. doi: 10.3760/cma.j.cn112137-20211227-02906.
To evaluate the efficacy of VRD (bortezomib+lenalidomide+dexamethasone) in newly diagnosed multiple myeloma (NDMM) patients as well as the effect of the regimen on the long-term prognosis. The clinical characteristics, survival rates, response rates and minimal residual disease (MRD) of patients with NDMM at Institute of Hematology & Blood Diseases Hospital from January 1, 2013 to January 1, 2020 were retrospectively analyzed. Subgroup analysis was also performed among groups according to the cytogenetics and autologous stem cell transplantation (ASCT) of patients. A total of 87 patients were retrospectively analyzed. The age[(,)] of all patients was 56 (51, 61) years and males and females accounted for 58.6% (51/87) and 41.4% (36/87), respectively. The overall response rate (ORR) was 95.9% (71/74) after 2 courses of induction therapy, with 13.5% (10/74) achieving the deep response [complete response (CR) or better] and 51.3% (38/74) of patients achieving a very good partial response (VGPR) or better. After 4 courses of induction therapy, the ORR achieved 95.2% (60/63), and the proportions of the deep response and VGPR or better grew up to 46.0% (29/63) and 77.7% (49/63). According to the treatment, the patients (≤65 years old) were divided into transplantation group and non-transplantation group. After the induction therapy, 88.8% (32/36) of patients in the transplantation group achieved VGPR or better, and 55.5% (20/36) reached the deep response. After the transplantation, the proportion increased to 97.1% (34/35) and 77.2% (27/35), respectively(88.8% vs 97.1%,=0.174;55.5% vs 77.2%,=0.055), with the rate of undetectable MRD increasing from 44.4% (16/36) to 77.8% (28/36) (=0.004). In the non-transplantation group, 74.2% (23/31) of patients achieved VGPR or better after 4 courses of induction therapy, 35.5% (11/31) of the patients achieved deep response and the rate of undetectable MRD was 37.0% (10/27). Compared with the non-transplantation group, transplantation was associated with a higher rate of complete response (89.5% vs 53.1%, <0.001) and a lower rate of MRD detection(78.4% vs 55.2%, =0.045). The median follow-up time of all patients was 26.3 months (20.8, 33.8). The median progression-free survival and overall survival were not reached. The three-year PFS and OS rates were 78.4% and 87.2%, respectively. None of the standard-risk group, the high-risk group, the transplantation group and non-transplantation group achieved the median PFS and OS. VRD regimen has a promising efficacy and results in a substantial survival benefit. ASCT after VRD induction therapy is associated with higher rate of deep response, higher rate of undetectable MRD and longer survival.
评估硼替佐米+来那度胺+地塞米松(VRD)方案在新诊断的多发性骨髓瘤(NDMM)患者中的疗效以及该方案对长期预后的影响。回顾性分析了2013年1月1日至2020年1月1日期间在血液学研究所血液病医院就诊的NDMM患者的临床特征、生存率、缓解率和微小残留病(MRD)情况。还根据患者的细胞遗传学和自体干细胞移植(ASCT)情况进行了亚组分析。共回顾性分析了87例患者。所有患者的年龄[(,)]为56(51,61)岁,男性和女性分别占58.6%(51/87)和41.4%(36/87)。诱导治疗2个疗程后总缓解率(ORR)为95.9%(71/74),其中13.5%(10/74)达到深度缓解[完全缓解(CR)或更好],51.3%(38/74)的患者达到非常好的部分缓解(VGPR)或更好。诱导治疗4个疗程后,ORR达到95.2%(60/63),深度缓解和VGPR或更好的比例分别增至46.0%(29/63)和77.7%(49/63)。根据治疗情况,将(≤65岁)患者分为移植组和非移植组。诱导治疗后,移植组88.8%(32/36)的患者达到VGPR或更好,55.5%(20/36)达到深度缓解。移植后,比例分别增至97.1%(34/35)和77.2%(27/35)(88.8%对97.1%,=0.174;55.5%对77.2%,=0.055),MRD检测不到的比例从44.4%(16/36)增至77.8%(28/36)(=0.004)。在非移植组中,诱导治疗4个疗程后74.2%(23/31)的患者达到VGPR或更好,35.5%(11/31)的患者达到深度缓解,MRD检测不到的比例为37.0%(10/27)。与非移植组相比,移植组的完全缓解率更高(89.5%对53.1%,<0.001),MRD检测率更低(78.4%对55.2%,=0.045)。所有患者的中位随访时间为26.3个月(20.8,33.8)。中位无进展生存期和总生存期均未达到。三年无进展生存率和总生存率分别为78.4%和87.2%。标准风险组、高风险组、移植组和非移植组均未达到中位无进展生存期和总生存期。VRD方案疗效显著,能带来显著的生存获益。VRD诱导治疗后进行ASCT与更高的深度缓解率、更低的MRD检测率和更长的生存期相关。