Outcome according to cytogenetic abnormalities and DNA ploidy in myeloma patients receiving short induction with weekly bortezomib followed by maintenance
Outcome according to cytogenetic abnormalities and DNA ploidy in myeloma patients receiving short induction with weekly bortezomib followed by maintenance
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DOI：
10.1182/blood-2011-04-345801
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发表时间：
2011-10-27
期刊：
影响因子：
20.3
通讯作者：
San Miguel, Jesus F.
中科院分区：
文献类型：
--
作者：
Mateos, Mara-Victoria;Gutierrez, Norma C.;San Miguel, Jesus F.
细胞遗传学异常（CA）如t（4;14）、t（14;16）或del（17 p）和非超二倍体与多发性骨髓瘤的不良预后相关。我们评估了232例新诊断的老年多发性骨髓瘤患者的CA（FISH）和DNA倍体（流式细胞术）对缓解和生存的影响，这些患者接受了每周一次硼替佐米诱导治疗，随后接受以硼替佐米为基础的联合维持治疗。高风险和标准风险CA组在诱导（21% vs 27%完全缓解[CR]）和维持（39% vs 45% CR）后的缓解相似。然而，高风险患者的无进展生存期（PFS）比标准风险患者短，无论是从第一次（24 vs 33个月; P = 0.04）和第二次随机化（17 vs 27个月; P = 0.01）。这也意味着高风险患者的总生存期（OS）较短（3年OS：55% vs 77%; P = 0.001）。这种不良预后适用于t（4; 14）或del（17 p）。关于DNA倍体，超二倍体患者的OS比非超二倍体患者长（3年时77% vs 63%; P = 0.04），这在硼替佐米、沙利度胺和泼尼松治疗的患者中更为明显（3年时77% vs 53%; P = 0.02）。本方案不能克服高危CA和非超二倍体的不良预后。本试验在www.ClinicalTrials.gov注册为NCT 00443235。（血。2011; 118（17）：4547-4553）
Cytogenetic abnormalities (CAs) such as t(4;14), t(14;16) or del(17p), and nonhyperdiploidy are associated with poor prognosis in multiple myeloma. We evaluated the influence of CAs by FISH and DNA ploidy by flow cytometry on response and survival in 232 elderly, newly diagnosed multiple myeloma patients receiving an induction with weekly bortezomib followed by maintenance therapy with bortezomib-based combinations. Response was similar in the high-risk and standard-risk CA groups, both after induction (21% vs 27% complete responses [CRs]) and maintenance (39% vs 45% CR). However, high-risk patients showed shorter progression-free survival (PFS) than standard-risk patients, both from the first (24 vs 33 months; P = .04) and second randomization (17 vs 27 months; P = .01). This also translated into shorter overall survival (OS) for high-risk patients (3-year OS: 55% vs 77%; P = .001). This adverse prognosis applied to either t(4; 14) or del(17p). Concerning DNA ploidy, hyperdiploid patients showed longer OS than nonhyperdiploid patients (77% vs 63% at 3 years; P = .04), and this was more evident in patients treated with bortezomib, thalidomide, and prednisone (77% vs 53% at 3 years; P = .02). The present schema does not overcome the negative prognosis of high-risk CAs and nonhyperdiploidy. This trial was registered with www.ClinicalTrials.gov as NCT00443235. (Blood. 2011; 118(17): 4547-4553)