硼替佐米联合来那度胺治疗伴有 1q21 增益/扩增的新诊断多发性骨髓瘤的疗效分析。
Efficacy Analysis of Bortezomib Combined with Lenalidomide in Newly Diagnosed Multiple Myeloma with 1q21 Gain/Amp.
机构信息
Hematology Department, Mianyang Central Hospital, School of Medicine. University of Electronic Science and Technology of China, Mianyang, China.
出版信息
Technol Cancer Res Treat. 2024 Jan-Dec;23:15330338241252605. doi: 10.1177/15330338241252605.
OBJECTIVE
1q21 gain/Amp is one of the most common cytogenetic abnormalities. There are controversies about its effects on prognosis and may be associated with inferior outcomes in patients with newly diagnosed multiple myeloma (NDMM). To explore the optimal induction treatment, we analyzed and compared the efficacy of combinations of bortezomib-lenalidomide-dexamethasone (VRD) and only bortezomib-based triplet regimens without lenalidomide (only bortezomib-based) as induction therapy in patients with NDMM with 1q21 gain/Amp.
METHODS
Seventy-six NDMM patients with 1q21 gain/Amp who were admitted to our center from 2016 to 2022 were retrospectively analyzed in this study. The progression and efficacy of the patients were observed.
RESULTS
Within our study group, the overall survival rate stood at 75.0%, and the progression-free survival (PFS) rate reached 40.8% in NDMM patients with 1q21 gain/Amp. The best outcome assessment was that 17.1% achieved complete response (CR) and 44.7% achieved very good partial response (VGPR). Patients in the VRD group had a deeper response (VGPR: 63.6% 37.0%, = 0.034), lower disease progression rate (31.8% 70.3%, = 0.002), longer sustained remission (median 49.7 months 18.3 months, = 0.030), and longer PFS (median 61.9 months 22.9 months, = 0.032) than those treated with only bortezomib-based induction therapy. No significant differences were found among patients with partial response or better (86.4% 77.8%, = 0.532) or CR (27.3% 13.0%, = 0.180). Multivariate analysis showed that only bortezomib-based induction therapy (= 0.003, HR 0.246, 95% CI 0.097-0.620), International Staging System stage III (= 0.003, HR 3.844, 95% CI 1.588-9.308) and LMR <3.6 (= 0.032, HR 0.491, 95% CI 0.257-0.940) were significantly associated with adverse PFS.
CONCLUSIONS
When compared with the sequential administration of bortezomib and lenalidomide or only bortezomib-based protocols, NDMM patients with 1q21 gain/Amp may benefit more from VRD as initial treatments.
目的
1q21 增益/扩增是最常见的细胞遗传学异常之一。其对预后的影响存在争议，可能与新诊断多发性骨髓瘤（NDMM）患者的预后不良有关。为了探索最佳诱导治疗方法，我们分析并比较了硼替佐米-来那度胺-地塞米松（VRD）联合方案和无来那度胺的仅硼替佐米三联方案（仅硼替佐米组）作为伴有 1q21 增益/扩增的 NDMM 患者诱导治疗的疗效。
方法
回顾性分析 2016 年至 2022 年期间我院收治的 76 例伴有 1q21 增益/扩增的 NDMM 患者，观察患者的进展和疗效。
结果
在本研究组中，伴有 1q21 增益/扩增的 NDMM 患者的总生存率为 75.0%，无进展生存率（PFS）为 40.8%。最佳疗效评估结果显示，完全缓解（CR）率为 17.1%，非常好的部分缓解（VGPR）率为 44.7%。VRD 组患者的反应更深（VGPR：63.6% 37.0%，=0.034），疾病进展率更低（31.8% 70.3%，=0.002），持续缓解时间更长（中位时间 49.7 个月 18.3 个月，=0.030），PFS 更长（中位时间 61.9 个月 22.9 个月，=0.032），而仅接受硼替佐米诱导治疗的患者则较低。部分缓解或更好（86.4% 77.8%，=0.532）或 CR（27.3% 13.0%，=0.180）患者之间无显著差异。多变量分析显示，仅硼替佐米诱导治疗（=0.003，HR 0.246，95%CI 0.097-0.620）、国际分期系统（ISS）III 期（=0.003，HR 3.844，95%CI 1.588-9.308）和 LMR<3.6（=0.032，HR 0.491，95%CI 0.257-0.940）与不良 PFS 显著相关。
结论
与硼替佐米和来那度胺序贯给药或仅硼替佐米方案相比，伴有 1q21 增益/扩增的 NDMM 患者可能从 VRD 初始治疗中获益更多。
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