Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Department of Internal Medicine, Discipline of Clinical Practical Skills, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Curr Oncol. 2022 Nov 8;29(11):8501-8512. doi: 10.3390/curroncol29110670.
Multiple myeloma (MM) is a hematologic cancer defined by an abnormal development of clonal plasma cells in the bone marrow, releasing vast quantities of immunoglobulins and different proteins. In the majority of patients, MM remains incurable despite decades of medical improvement and a number of treatment breakthroughs. Frontline standard-of-care has little long-term success, with the majority of patients eventually relapsing, although the overall progression-free survival (PFS) has improved significantly in the last ten years. Patients who are eligible for a transplant have the highest PFS rate at 5 years, depending on medication response and other various factors that are yet to be discovered. Therefore, the current study aimed to evaluate the response to VCD (bortezomib, cyclophosphamide, dexamethasone) and VTD (bortezomib, thalidomide, dexamethasone) used as pretransplant regimens, as well as to compare responses between thalidomide and lenalidomide used as maintenance therapy posttransplant. This retrospective study was performed on a group of 105 hospitalized patients in the Hematology Department of the Timisoara Municipal Emergency Clinical Hospital between January 2016 and December 2021. Data was collected from the paper records of patients with MM who were under-followed. The treatment regimens used as induction therapy were either VCD or VTD if cyclophosphamide was contraindicated. Of the 105 patients, 27 became eligible for bone marrow transplantation. Furthermore, they received maintenance therapy which was based on either lenalidomide with dexamethasone or thalidomide with dexamethasone. Of the 62 patients treated with VTD, 17.7% were in complete remission before stem cell transplantation. Of the 43 patients treated with VCD, 37.2% were in complete remission. The 5-year mean progression-free survival (PFS) in the entire cohort was better in the group treated with the VTD regimen (31.6 vs. 27.2 months). However, in the 27 patients undergoing maintenance after ASCT, the PFS with thalidomide was 35.5 months (95% CI = 27-42), while the PFS rate in those receiving maintenance treatment with lenalidomide was 46.1 months (95% CI = 20-73). VCD proved to be superior to VTD in inducing complete pretransplant responses. Regarding maintenance therapy, patients from the lenalidomide group had superior responses compared with those under thalidomide.
多发性骨髓瘤（MM）是一种血液系统恶性肿瘤，其特征为骨髓中克隆性浆细胞异常增生，大量分泌免疫球蛋白和其他多种蛋白。尽管医学水平在过去几十年间取得了显著进步，并且出现了多种治疗突破，但多数患者的病情仍无法治愈。一线标准疗法的长期疗效有限，大多数患者最终会复发，尽管过去十年间无进展生存期（PFS）显著改善。适合移植的患者 5 年 PFS 率最高，具体取决于药物反应和其他尚未发现的各种因素。因此，本研究旨在评估硼替佐米、环磷酰胺、地塞米松（VCD）和硼替佐米、沙利度胺、地塞米松（VTD）作为移植前方案的疗效，并比较移植后作为维持治疗使用的沙利度胺和来那度胺的疗效。本回顾性研究于 2016 年 1 月至 2021 年 12 月在蒂米什瓦拉市立紧急临床医院血液科对 105 例住院患者进行，数据来自随访不充分的 MM 患者的纸质病历。如果环磷酰胺禁忌，则诱导治疗方案采用 VCD 或 VTD。105 例患者中，27 例符合骨髓移植条件。他们接受了维持治疗，方案为来那度胺联合地塞米松或沙利度胺联合地塞米松。62 例接受 VTD 治疗的患者中，17.7%在干细胞移植前达到完全缓解。43 例接受 VCD 治疗的患者中，37.2%达到完全缓解。整个队列的 5 年平均无进展生存期（PFS）在 VTD 治疗组更好（31.6 个月比 27.2 个月）。然而，在 27 例接受 ASCT 后维持治疗的患者中，沙利度胺的 PFS 为 35.5 个月（95%CI=27-42），而接受来那度胺维持治疗的患者 PFS 为 46.1 个月（95%CI=20-73）。VCD 在诱导完全移植前缓解方面优于 VTD。在维持治疗方面，来那度胺组患者的反应优于沙利度胺组。
