Comparison of high-dose melphalan with a more intensive regimen of thiotepa, busulfan, and cyclophosphamide for patients with multiple myeloma
Comparison of high-dose melphalan with a more intensive regimen of thiotepa, busulfan, and cyclophosphamide for patients with multiple myeloma
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DOI：
10.1002/cncr.20294
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发表时间：
2004-06-12
期刊：
影响因子：
6.2
通讯作者：
Giralt, S
中科院分区：
文献类型：
--
作者：
Anagnostopoulos, A;Aleman, A;Giralt, S
背景资料。作为初始治疗方案的一部分，大剂量化疗(HDC)和自体干细胞移植(ASCT)可改善多发性骨髓瘤患者的无进展生存期(PFS)和总生存期(OS)。多发性骨髓瘤患者的最佳准备方案尚未确定。在目前的研究中，作者比较了在多发性骨髓瘤患者中，大剂量马法兰(HDM)和更强化的硫替巴、丁硫丹和环磷酰胺(TBC)方案的结果。方法：186名新诊断的多发性骨髓瘤患者(中位年龄，51岁)接受HDC联合ASCT以巩固首次缓解(n=108)或用于治疗原发难治性疾病(n=78)。70名患者在诊断时有一个大的肿瘤肿块。TBC组97例，HDM组89例。结果TBC组的有效率(完全缓解[CR]和部分缓解[PR])与HDM组相似(总有效率为66%；CR率为17%；PR率为49%)；HDM组(总有效率为69%；CR率为28%；PR率为41%)。两组的PFS和OS相似。比例风险回归模型显示，Durie-Salmon病的诊断阶段和接受过三种或三种以上的治疗方案是预测PFS的唯一因素；准备方案的类型不影响结果。结论：目前的研究结果表明，与HDM相比，在多发性骨髓瘤患者中使用更密集的方案并不能改善结果。HDM应该继续被认为是骨髓瘤患者的标准准备方案。(C)2004年美国癌症协会。
BACKGROUND. High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) as part of the initial treatment regimen improves progression-free survival (PFS) and overall survival (OS) for patients with multiple myeloma. The optimal preparative regimen for patients with multiple myeloma has yet to be defined. In the current study, the authors compared the outcomes associated with high-dose melphalan (HDM) and a more intensive regimen of thiotepa, busulfan, and cyclophosphamide (TBC) in patients with multiple myeloma.METHODS. One hundred eighty-six patients with newly diagnosed multiple myeloma (median age, 51 years) received HDC with ASCT for consolidation of first remission (n = 108) or for treatment of primary refractory disease (n = 78). Seventy patients had a large tumor mass at the time of diagnosis. The preparative regimen consisted of TBC for 97 patients and HDM for 89 patients. Patients in the TBC group were younger and had more advanced disease stage at diagnosis and at the time of ASCT compared with patients in the HDM group.RESULTS. The response rates (complete response [CR] and partial response [PR]) were similar in the TBC group (overall response rate, 66%; CR rate, 17%; PR rate, 49%) and the HDM group (overall response rate, 69%; CR rate, 28%; PR rate, 41%). PFS and OS were similar in both groups. A proportional hazards regression model revealed that Durie-Salmon disease stage at diagnosis and having received three or more previous treatment regimens were the only factors that predicted PFS; the type of preparative regimen did not influence outcome.CONCLUSIONS. The results of the current study indicate that the use of a more intensive regimen did not improve results compared with HDM in patients with multiple myeloma. HDM should continue to be considered the standard preparative regimen for patients with myeloma. (C) 2004 American Cancer Society.