Nakamura Naokazu, Arima Nobuyoshi, Takakuwa Teruhito, Yoshioka Satoshi, Imada Kazunori, Fukushima Kentaro, Hotta Masaaki, Fuchida Shin-Ichi, Kanda Junya, Uoshima Nobuhiko, Shimura Yuji, Tanaka Hirokazu, Ohta Kensuke, Kosugi Satoru, Yagi Hideo, Yoshihara Satoshi, Yamamura Ryosuke, Adachi Yoko, Hanamoto Hitoshi, Shibayama Hirohiko, Hosen Naoki, Ito Tomoki, Shimazaki Chihiro, Takaori-Kondo Akifumi, Kuroda Junya, Matsumura Itaru, Hino Masayuki
Department of Hematology, Shinko Hospital, 1-4-47, Wakihamacho, Chuo-Ku, Kobe, Hyogo, 651-0072, Japan.
Department of Hematology and Oncology Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Hematol. 2024 Dec;103(12):5681-5690. doi: 10.1007/s00277-024-05705-z. Epub 2024 Mar 16.
Elotuzumab-based regimens are sometimes selected for multiple myeloma treatment after daratumumab-based regimens. However, there has been insufficient discussion on the efficacy of elotuzumab after daratumumab. We used Kansai Myeloma Forum registration data in a multicenter retrospective evaluation of the efficacy of elotuzumab after daratumumab. Overall survival (OS) rate and time to next treatment (TTNT) were significantly worse in the cohort given elotuzumab after daratumumab (Dara cohort, n = 47) than in the cohort with no history of daratumumab administration before elotuzumab (No-Dara cohort, n = 80, OS: P = 0.03; TTNT: P = 0.02; best response: P < 0.01). In the Dara cohort, OS and TTNT rates were worse with sequential elotuzumab use after daratumumab than with non-sequential (OS: P = 0.02; TTNT: P = 0.03). In patients given elotuzumab < 180 days after daratumumab, OS (P = 0.08) and best response (P = 0.21) tended to be worse, and TTNT was significantly worse (P = 0.01), than in those given elotuzumab after ≥ 180 days. These findings were confirmed by subgroup analyses and multivariate analyses. Monoclonal-antibody-free treatment might be preferable after daratumumab-based regimens. If possible, elotuzumab-based regimens should be considered only ≥ 180 days after daratumumab use.
基于埃罗妥珠单抗的治疗方案有时会在基于达雷妥尤单抗的治疗方案之后被选用于多发性骨髓瘤的治疗。然而,对于达雷妥尤单抗之后使用埃罗妥珠单抗的疗效,目前的讨论还不够充分。我们利用关西骨髓瘤论坛的注册数据,对达雷妥尤单抗之后使用埃罗妥珠单抗的疗效进行了多中心回顾性评估。在达雷妥尤单抗之后使用埃罗妥珠单抗的队列(达雷妥尤单抗队列,n = 47)中,总生存期(OS)率和至下次治疗时间(TTNT)显著差于在使用埃罗妥珠单抗之前没有达雷妥尤单抗用药史的队列(无达雷妥尤单抗队列,n = 80,OS:P = 0.03;TTNT:P = 0.02;最佳缓解:P < 0.01)。在达雷妥尤单抗队列中,达雷妥尤单抗之后序贯使用埃罗妥珠单抗的OS和TTNT率比非序贯使用时更差(OS:P = 0.02;TTNT:P = 0.03)。在达雷妥尤单抗后<180天使用埃罗妥珠单抗的患者中,OS(P = 0.08)和最佳缓解(P = 0.21)有变差的趋势,且TTNT显著更差(P = 0.01),而在达雷妥尤单抗后≥180天使用埃罗妥珠单抗的患者中则不然。这些发现通过亚组分析和多变量分析得到了证实。在基于达雷妥尤单抗的治疗方案之后,无单克隆抗体的治疗可能更可取。如果可能的话,基于埃罗妥珠单抗的治疗方案应仅在使用达雷妥尤单抗≥180天后考虑。