Long-Term Follow-Up Results of Lenalidomide, Bortezomib, and Dexamethasone Induction Therapy and Risk-Adapted Maintenance Approach in Newly Diagnosed Multiple Myeloma
Long-Term Follow-Up Results of Lenalidomide, Bortezomib, and Dexamethasone Induction Therapy and Risk-Adapted Maintenance Approach in Newly Diagnosed Multiple Myeloma
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DOI：
10.1200/jco.19.02515
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发表时间：
2020-06-10
影响因子：
45.3
通讯作者：
Nooka, Ajay K.
中科院分区：
文献类型：
--
作者：
Joseph, Nisha S.;Kaufman, Jonathan L.;Nooka, Ajay K.
目的对于符合移植资格和不符合移植资格的骨髓瘤患者来说，来那度胺、硼替佐米和地塞米松 (RVD) 的组合是一种高效且方便的诱导方案。在此，我们介绍了最大的连续接受 RVD 诱导治疗、随后进行风险适应维持治疗的患者队列，以及最长的随访时间和有关长期结果的重要信息。患者和方法我们描述了 2007 年 1 月至 2016 年 8 月期间接受 RVD 诱导治疗的连续 1,000 名新诊断骨髓瘤患者。人口统计学、临床特征和结果数据来自我们的机构审查 委员会批准的骨髓瘤数据库。根据国际骨髓瘤工作组统一缓解标准评估缓解和进展。 结果诱导治疗后的总体缓解率为 97.1%，移植后的总体缓解率为 98.5%，其中 89.9% 的患者在中位随访时间 67 个月时达到非常好的部分缓解 (VGPR) 或更好，33.3% 的患者在移植后达到严格的完全缓解。整个队列的估计中位无进展生存时间为 65 个月（95% CI，58.7 至 71.3 个月），高危患者为 40.3 个月（95% CI，33.5 至 47 个月），标准风险患者为 76.5 个月（95% CI，66.9 至 86.2 个月）。整个队列的中位总生存 (OS) 时间为 126.6 个月（95% CI，113.3 至 139.8 个月）。高风险患者的中位 OS 为 78.2 个月（95% CI，62.2 至 94.2 个月），而标准风险患者尚未达到该水平。高风险和标准风险患者的五年 OS 率分别为 57% 和 81%，10 年 OS 率分别为 29% 和 58%。 结论 RVD 是一种诱导方案，可在移植后为近 90% 的患者提供高缓解率（VGPR 或更好），并且风险适应的维持可以带来前所未有的长期结果。这项研究包括迄今为止报道的最大的 RVD 治疗患者队列，并进行了长期随访，并证明了 3 种药物诱导方案能够为新诊断的多发性骨髓瘤患者带来显着的生存获益。
PURPOSEThe combination of lenalidomide, bortezomib, and dexamethasone (RVD) is a highly effective and convenient induction regimen for both transplantation-eligible and -ineligible patients with myeloma. Here, we present the largest cohort of patients consecutively treated with RVD induction therapy followed by risk-adapted maintenance therapy with the longest follow-up and important information on long-term outcomes.PATIENTS AND METHODSWe describe 1,000 consecutive patients with newly diagnosed myeloma treated with RVD induction therapy from January 2007 until August 2016. Demographic and clinical characteristics and outcomes data were obtained from our institutional review board-approved myeloma database. Responses and progression were evaluated per International Myeloma Working Group Uniform Response Criteria.RESULTSThe overall response rate was 97.1% after induction therapy and 98.5% after transplantation, with 89.9% of patients achieving a very good partial response (VGPR) or better and 33.3% achieving stringent complete response after transplantation at a median follow-up time of 67 months. The estimated median progression-free survival time was 65 months (95% CI, 58.7 to 71.3 months) for the entire cohort, 40.3 months (95% CI, 33.5 to 47 months) for high-risk patients, and 76.5 months (95% CI, 66.9 to 86.2 months) for standard-risk patients. The median overall survival (OS) time for the entire cohort was 126.6 months (95% CI, 113.3 to 139.8 months). The median OS for high-risk patients was 78.2 months (95% CI, 62.2 to 94.2 months), whereas it has not been reached for standard-risk patients. Five-year OS rates for high-risk and standard-risk patients were 57% and 81%, respectively, and the 10-year OS rates were 29% and 58%, respectively.CONCLUSIONRVD is an induction regimen that delivers high response rates (VGPR or better) in close to 90% of patients after transplantation, and risk-adapted maintenance can deliver unprecedented long-term outcomes. This study includes the largest cohort of patients treated with RVD reported to date with long follow-up and demonstrates the ability of 3-drug induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.