Zuo Xinyu, Yang Apeng, Chen Pingping, Xie Yanhui, Zeng Zhiyong, Ma Jiexian
Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China.
Department of Hematology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Int J Med Sci. 2025 Apr 28;22(10):2373-2381. doi: 10.7150/ijms.110231. eCollection 2025.
Multiple myeloma is the second most common hematologic malignancy in older patients. The standard front-line VRD regimen (bortezomib/lenalidomide/dexamethasone) achieves high efficacy but is associated with significant toxicity, leading to infections, bone marrow suppression, and treatment discontinuation in approximately 20% of patients. Alternative regimens with reduced toxicity are needed for this demographic. Prior studies suggest adding arsenic trioxide to bortezomib/dexamethasone (BD) enhances remission depth with acceptable safety, while bortezomib/thalidomide/dexamethasone (VTD) offers reduced toxicity, but lower efficacy compared to VRD. This study evaluates the efficacy, safety, and cost-effectiveness of an arsenic trioxide-VTD regimen (AVTD) versus VRD in newly diagnosed multiple myeloma (NDMM) patients. Among 116 participants, AVTD demonstrated comparable efficacy to VRD but significantly reduced infection rates (14.0% vs. 40.7%, P < 0.001) and severe bone marrow suppression (0% vs. 11.9%, P = 0.013). Subgroup analysis of patients >60 years yielded consistent results. Additionally, AVTD was associated with lower treatment costs. In conclusion, the AVTD regimen offers a safer, more cost-effective alternative to VRD for NDMM, particularly in older adult patients, without compromising treatment efficacy.
多发性骨髓瘤是老年患者中第二常见的血液系统恶性肿瘤。标准的一线VRD方案（硼替佐米/来那度胺/地塞米松）疗效显著，但伴有明显毒性，约20%的患者会出现感染、骨髓抑制并导致治疗中断。这一人群需要毒性更低的替代方案。先前的研究表明，在硼替佐米/地塞米松（BD）方案中加入三氧化二砷可提高缓解深度且安全性可接受，而硼替佐米/沙利度胺/地塞米松（VTD）方案毒性较低，但与VRD相比疗效较差。本研究评估了三氧化二砷-VTD方案（AVTD）与VRD方案在新诊断的多发性骨髓瘤（NDMM）患者中的疗效、安全性和成本效益。在116名参与者中，AVTD方案显示出与VRD方案相当的疗效，但感染率显著降低（14.0%对40.7%，P<0.001），严重骨髓抑制发生率也显著降低（0%对11.9%，P=0.013）。对60岁以上患者的亚组分析得出了一致的结果。此外，AVTD方案的治疗成本更低。总之，对于NDMM患者，尤其是老年成年患者，AVTD方案是一种更安全、更具成本效益的VRD替代方案，且不影响治疗效果。
