Department of Medicine, Division of Hematology/Oncology, Indiana University, Indianapolis, IN.
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Lymphoma Myeloma Leuk. 2024 Oct;24(10):e336-e343. doi: 10.1016/j.clml.2024.05.021. Epub 2024 Jun 3.
Lenalidomide (R), bortezomib (V), and dexamethasone (d) is a standard-of-care regimen in newly diagnosed multiple myeloma (NDMM); however, characteristics and outcomes for nontransplanted patients receiving frontline RVd are not well understood.
The Connect MM Registry is a large, US, multicenter, prospective observational cohort study of NDMM patients.
This analysis investigated characteristics and outcomes of patients who received RVd alone or followed by Rd or R (RVd ± Rd/R) who did not undergo frontline autologous stem cell transplantation.
As of August 2021, 314 of 1979 nontransplanted patients received RVd ± Rd/R as initial therapy. Of these, 135 were aged ≤ 65 years and 179 were > 65 years. 108 patients had time to relapse (TTR) of ≤ 12 months and 182 had TTR > 12 months. Baseline characteristics were comparable regardless of TTR and age group except renal function, which was more commonly impaired in older patients. Among patients aged ≤ 65 and > 65 years, median duration of first-line treatment was 6.3 and 9.0 months, median time to next line for those who received second-line therapy was 15.5 and 15.2 months, median progression-free survival (PFS) was 19.3 and 23.0 months, and median overall survival was 60.0 and 59.1 months, respectively. High-risk disease (per IMWG criteria) and high serum calcium were associated with higher hazard of progression or death; the adjusted PFS hazard ratio with respect to age (≤ 65 vs. > 65 years) based on multivariable analysis was 1.18 (0.89-1.57; P = .25).
These results indicate RVd is active across age groups and provide a better understanding of outcomes with RVd in NDMM.
来那度胺（R）、硼替佐米（V）和地塞米松（d）是新诊断多发性骨髓瘤（NDMM）的标准治疗方案；然而，对于未接受一线 RVd 治疗的非移植患者的特征和结局尚不清楚。
Connect MM 登记处是一项大型的美国多中心前瞻性观察队列研究，纳入了 NDMM 患者。
本分析调查了接受单独 RVd 或随后接受 Rd 或 R（RVd ± Rd/R）治疗但未接受一线自体干细胞移植的患者的特征和结局。
截至 2021 年 8 月，1979 名未接受移植的患者中有 314 名接受了 RVd ± Rd/R 作为初始治疗。其中，135 名年龄≤65 岁，179 名年龄＞65 岁。108 名患者的缓解时间（TTR）≤12 个月，182 名患者的 TTR＞12 个月。无论 TTR 和年龄组如何，基线特征都相似，除了肾功能，老年患者的肾功能更常受损。在年龄≤65 岁和＞65 岁的患者中，一线治疗的中位持续时间分别为 6.3 和 9.0 个月，接受二线治疗的患者的中位二线治疗时间分别为 15.5 和 15.2 个月，中位无进展生存期（PFS）分别为 19.3 和 23.0 个月，中位总生存期分别为 60.0 和 59.1 个月。根据 IMWG 标准，高危疾病和高血清钙与更高的进展或死亡风险相关；多变量分析显示，年龄（≤65 岁与＞65 岁）与调整后的 PFS 风险比为 1.18（0.89-1.57；P=0.25）。
这些结果表明，RVd 在各年龄段均具有活性，并提供了对 NDMM 中 RVd 治疗结果的更好理解。
