RVD方案治疗多发性骨髓瘤的疗效及安全性研究  

Efficacy and safety of combined treatment of lenalidomide,bortezomib,and dexamethasone on patients with multiple myeloma

作　　者：吴超[1] 徐文彬[1] 黄磊[1] 叶晨静[1] 阎骅[1] 俞晴[1] WU Chao;XU Wenbin;HUANG Lei;YE Chenjing;YAN Hua;YU Qing(VIP Health Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院特需医疗保健中心,上海200025

出　　处：《内科理论与实践》2020年第4期251-256,共6页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:评价来那度胺、硼替佐米及地塞米松(RVD)方案治疗多发性骨髓瘤(multiple myeloma,MM)患者的疗效及安全性。方法:回顾性分析2016年1月至2019年12月在我中心接受RVD方案治疗的新诊断MM(newly diagnosed MM,NDMM)及复发/难治MM(relapsed/refractory MM,RRMM)患者共28例,其中NDMM 10例,RRMM 18例,评估RVD方案诱导及挽救治疗后的疗效及安全性。在NDMM中比较RVD方案与硼替佐米、多柔比星或脂质体多柔比星及地塞米松(PAD)方案的疗效。结果:10例NDMM中位治疗周期为3个周期,中位起效时间1.0个月,诱导治疗后总缓解率(overall response rate,ORR)90.0%,完全缓解(complete response,CR)率40.0%,非常好的部分缓解(very good partial response,VGPR)率20.0%,1例高危患者诱导治疗后CR;中位随访时间5.0个月,中位无进展生存(progression free survival,PFS)期及总生存(overall survival,OS)期均未达到。18例RRMM中位治疗周期为6个周期,中位起效时间2.0个月,挽救治疗后ORR为72.2%,CR率22.2%,VGPR率27.8%,4例高危患者的ORR为100.0%,1例硼替佐米及沙利度胺双耐药患者治疗后疾病进展(progressive disease,PD);中位随访时间20.5个月,中位PFS期33.0个月,中位OS期未达到。RVD方案诱导治疗NDMM的ORR与PAD方案比较(90.0%比80.7%)差异无统计学意义。RVD方案治疗相关3级以上不良事件发生率14.3%,主要血液学毒性为中性粒细胞减少、血小板减少,主要非血液学毒性为呼吸道感染、皮疹。1例因不良事件中断治疗,无导致死亡不良事件发生。结论:RVD方案治疗NDMM及RRMM患者具有良好的疗效及安全性。Objective To evaluate the efficacy and safety of combined therapy of lenalidomide,bortezomib,and dexamethasone(RVD)in Chinese patients with multiple myeloma(MM).Methods A total of 28 patients,including 10 with newly diagnosed MM(NDMM)and 18 with relapsed/refractory MM(RRMM),placed on RVD regimen therapy between January 2016 and December 2019 were retrospectively analyzed to assess the treatment response,survival and safety.The efficacy of RVD was compared with that of bortezomib,doxorubicin or liposome doxorubicin and dexamethasone(PAD)combination on treatment of NDMM.Results Of 10 NDMM patients receiving multi-cycles(median:3)of RVD,the median time to response was 1.0 month.The overall response rate(ORR)in NDMM was 90.0%,of which 40.0%and 20.0%was complete response(CR)and very good partial response(VGPR),respectively.One high risk MM patient had CR after induction.The median progression free survival(PFS)and overall survival(OS)were not reached for a median follow-up time of 5.0 months.The 18 RRMM patients received median 6 cycles of RVD and had a median time to response of 2.0 months.The ORR in RRMM was 72.2%,of which 22.2%and 27.8%was CR and VGPR,respectively.The ORR of 4 high risk RRMM was 100.0%.The response of 1 bortezomib and thalidomide refractory patient was progressive disease(PD).During a median follow-up time of 20.5 months,the median PFS was 33.0 months with unreached median OS.The difference in ORR(90.0%vs 80.7%)between RVD and PAD in NDMM was not statistically significant.The high grade adverse events(AEs)(≥3)related to RVD were reported in 14.3%patients.The most common hematologic AEs were neutropenia and thrombocytopenia.The most common non-hematologic AEs were respiratory infection and rash.Treatment was discontinued in 1 patient due to severe AE.There was no treatment-related death.Conclusions RVD combination is generally effective and safe in NDMM and RRMM patients.

关 键 词：多发性骨髓瘤 来那度胺 硼替佐米 疗效 安全性 

分 类 号：R733.3[医药卫生—肿瘤]