de Queiroz Crusoé Edvan, Leal Ribeiro Dos Santos Joanna Suzana, de Andrade Santos Juliana, de Melo Santos Herbert Henrique, de Souza Santos Allan, Lucas Larissa Ferreira, Requião de Pinna Cristiane Almeida, Caldas Freire Paula Nogueira, Araujo de Jesus Adriano, de Moura Almeida Alessandro, Dutra Daniela Dourado, Chaves Marcos Fonseca, Nicanor Jamile Souza, Salvino Marco Aurelio, Bomfim Arruda Maria da Gloria, Hungria Vania
Hospital Universitário Professor Edgar Santos, Federal University of Bahia, Hematology and Hemotherapy Department, Salvador, Brazil.
Rede D'or Oncologia, Hematology Division, Salvador, Brazil.
Blood Neoplasia. 2025 Mar 3;2(3):100081. doi: 10.1016/j.bneo.2025.100081. eCollection 2025 Aug.
Anti-CD38 monoclonal antibodies have been successfully combined with immunomodulatory agents, proteasome inhibitors (PIs), alkylators, and corticosteroids in newly diagnosed multiple myeloma (NDMM). We assessed a regimen of daratumumab, cyclophosphamide, thalidomide, and dexamethasone (Dara-CTD) for patients with NDMM eligible to autologous stem cell transplantation (ASCT). Patients received 4 28-day cycles of induction therapy with Dara-CTD followed by ASCT, 4 cycles of consolidation Dara-TD, and single-agent daratumumab maintenance until progression or limiting toxicity. The primary end point was the percentage of patients achieving at least a very good partial response (VGPR) after the second cycle of consolidation. A key secondary end point was progression-free survival (PFS). We enrolled 24 patients, with a median age of 59.5 years, 62.5% of whom were female. Patients received a median of 28 treatment cycles. The rate of VGPR or better was 75.0% (95% confidence interval, 68.3-98.7); of 18 responding patients, 3 had a complete and 15 had a VGPR. The response duration varied between 9.5 and 41.9 months (median not reached). The estimated PFS rate at 36 months was 65%, and the overall survival rate at 48 months was 70%. The most frequent toxicity was constipation, febrile neutropenia, lymphopenia, neutropenia, peripheral neuropathy, and stomatitis. There were 7 documented cases of coronavirus disease 2019, 2 of which fatal. Two patients had permanent treatment discontinuation due to toxicity, 1 case each attributed to cyclophosphamide and daratumumab. Dara-CTD is an active, PI-free, quadruplet regimen with an acceptable safety profile for patients with ASCT-eligible NDMM. This trial was registered at www.ClinicalTrials.gov as #NCT03792620 and in the Plataforma Brasil at https://plataformabrasil.saude.gov.br as #CAAE96591818.0.0000.0048.
抗CD38单克隆抗体已成功与免疫调节剂、蛋白酶体抑制剂(PIs)、烷化剂和皮质类固醇联合用于新诊断的多发性骨髓瘤(NDMM)。我们评估了达雷妥尤单抗、环磷酰胺、沙利度胺和地塞米松(Dara-CTD)方案用于适合自体干细胞移植(ASCT)的NDMM患者。患者接受4个28天周期的Dara-CTD诱导治疗,随后进行ASCT,4个周期的Dara-TD巩固治疗,以及单药达雷妥尤单抗维持治疗,直至疾病进展或出现毒性限制。主要终点是巩固治疗第二个周期后达到至少非常好的部分缓解(VGPR)的患者百分比。一个关键的次要终点是无进展生存期(PFS)。我们招募了24名患者,中位年龄为59.5岁,其中62.5%为女性。患者接受的治疗周期中位数为28个。VGPR或更好的缓解率为75.0%(95%置信区间,68.3 - 98.7);在18名有反应的患者中,3名达到完全缓解,15名达到VGPR。缓解持续时间在9.5至41.9个月之间(未达到中位数)。36个月时的估计PFS率为65%,48个月时的总生存率为70%。最常见的毒性是便秘、发热性中性粒细胞减少、淋巴细胞减少、中性粒细胞减少、周围神经病变和口腔炎。有7例记录在案的2019冠状病毒病病例,其中2例死亡。2名患者因毒性而永久停止治疗,各有1例分别归因于环磷酰胺和达雷妥尤单抗。Dara-CTD是一种有效的、不含PI的四联方案,对于适合ASCT的NDMM患者具有可接受的安全性。本试验在www.ClinicalTrials.gov上注册为#NCT03792620,在巴西平台https://plataformabrasil.saude.gov.br上注册为#CAAE96591818.0.0000.0048。
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