Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma.
Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma.
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DOI：
10.1038/bcj.2017.46
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发表时间：
2017-06-16
影响因子：
12.8
通讯作者：
Rajkumar SV
中科院分区：
文献类型：
--
作者：
Ravi P;Kumar S;Gonsalves W;Buadi F;Lacy MQ;Go RS;Dispenzieri A;Kapoor P;Lust JA;Dingli D;Lin Y;Russell SJ;Leung N;Gertz MA;Kyle RA;Bergsagel PL;Rajkumar SV
关于多发性骨髓瘤（MM）治疗对未受累免疫球蛋白（IG）的影响知之甚少。我们确定了2000年至2013年期间在我们机构接受高剂量地塞米松（HD-DEX）、来那度胺和地塞米松（RD）、硼替佐米和地塞米松（VD）、硼替佐米、环磷酰胺和地塞米松（VCD）或硼替佐米、来那度胺和地塞米松（VRD）治疗新诊断MM的448例患者，并且在基线和4个周期治疗结束时具有绝对淋巴细胞计数（ALC）和定量未参与的IG的可用数据。治疗组间ALC和未受累IG的变化显著不同，VCD和HD-DEX导致未受累IG降低，RD、VD和VRD导致未受累IG升高。此外，在多变量分析中，RD、VD和VRD治疗与主要未受累IG增加≥ 25%或正常化的几率较高独立相关。虽然在4个周期的治疗后，主要未受累的IG达到体液应答与达到VGPR或更好的几率较高相关，但与总生存期改善无关。这些数据突出了MM药物的不同作用机制，并指出了使用VCD治疗抗体介导的自身免疫性疾病的可能作用。
Little is known about the impact of multiple myeloma (MM) treatment on uninvolved immunoglobulins (Ig). We identified 448 patients who received high-dose dexamethasone (HD-DEX), lenalidomide and dexamethasone (RD), bortezomib and dexamethasone (VD), bortezomib, cyclophosphamide and dexamethasone (VCD) or bortezomib, lenalidomide and dexamethasone (VRD) for newly diagnosed MM at our institution between 2000 and 2013, and who had available data on absolute lymphocyte count (ALC) and quantitative uninvolved Ig at baseline and at the end of four cycles of therapy. Changes in ALC and uninvolved Ig were significantly different across treatments, with VCD and HD-DEX producing reductions in uninvolved Ig, and RD, VD and VRD leading to increases in uninvolved Ig. In addition, treatment with RD, VD and VRD was independently associated with higher odds of achieving a ⩾25% increase in or normalization of the primary uninvolved Ig on multivariate analysis. Although achievement of a humoral response in the primary uninvolved Ig was associated with a higher odds of achieving VGPR or better after four cycles of therapy, it was not associated with improved overall survival. These data highlight the different mechanisms of action of MM drugs and point toward a possible role for the use of VCD in treating antibody-mediated autoimmune disease.
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影响因子：
158.5
作者：
Lonial, Sagar;Dimopoulos, Meletios;Richardson, Paul
通讯作者：
Richardson, Paul
影响因子：
6.5
作者：
Sanchez, Eric;Li, Mingjie;Berenson, James R.
通讯作者：
Berenson, James R.
影响因子：
2.8
作者：
Shen, Xianjuan;Guo, Yuehua;Ju, Shaoqing
通讯作者：
Ju, Shaoqing
多发性骨髓瘤：诊断和治疗。
影响因子：
8.9
作者：
Rajkumar SV;Kumar S
通讯作者：
Kumar S
影响因子：
12.8
作者：
Dimopoulos MA;Swern AS;Li JS;Hussein M;Weiss L;Nagarwala Y;Baz R
通讯作者：
Baz R