Zhao Weiwei, Chen Liyan, Wang Lianjie, Wang Wei
Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Street, Nangang, Harbin, 150081 People's Republic of China.
Indian J Hematol Blood Transfus. 2023 Jul;39(3):383-391. doi: 10.1007/s12288-022-01610-5. Epub 2022 Dec 8.
The prognosis of multiple extramedullary plasmacytomas (MEP) and plasma cell leukemia (PCL) is extremely poor, with the median overall survival (OS) of only 8 months with standard chemotherapy. Innovative treatment approaches incorporating various strategies are required to improve outcome. From November 2019 to September 2021, a total of 12 newly diagnosed MEP or PCL patients were enrolled in our department. An intensive chemotherapy treatment as VRD-PDCE consisted of bortezomib, lenalidomide, dexamethasone plus cisplatin, pegylated liposomal doxorubicin, cyclophosphamide and etoposide was first proposed. Disease activity and toxicity were evaluated after each cycle. Of the patients receiving therapy achieved a rapid and sustained response, and the overall response rate (ORR) was up to 75%. Nine patients achieved partial response (PR) or better, the response was the best response and the median time to best response was 4 cycles. Median overall survival (OS) and progression-free survival (PFS) were 24 (5-30) months and 18 (2-23) months. The toxicities were acceptable and there was no treatment related mortality. Our intensive treatment showed encouraging results in terms of disease control and improving survival, VRD-PDCE may be a novel regimen which is feasible and generally well-tolerated in MEP or PCL patients.
多发性髓外浆细胞瘤(MEP)和浆细胞白血病(PCL)的预后极差,采用标准化疗时的中位总生存期(OS)仅为8个月。需要采用包含各种策略的创新治疗方法来改善预后。2019年11月至2021年9月,共有12例新诊断的MEP或PCL患者入组我科。首次提出了一种以硼替佐米、来那度胺、地塞米松加顺铂、聚乙二醇化脂质体阿霉素、环磷酰胺和依托泊苷组成的VRD-PDCE强化化疗方案。每个周期后评估疾病活性和毒性。接受治疗的患者均实现了快速且持续的缓解,总缓解率(ORR)高达75%。9例患者达到部分缓解(PR)或更好,该缓解为最佳缓解,达到最佳缓解的中位时间为4个周期。中位总生存期(OS)和无进展生存期(PFS)分别为24(5-30)个月和18(2-23)个月。毒性反应可接受,且无治疗相关死亡。我们的强化治疗在疾病控制和改善生存方面显示出令人鼓舞的结果,VRD-PDCE可能是一种对MEP或PCL患者可行且耐受性普遍良好的新方案。
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