A staged approach with vincristine, adriamycin, and dexamethasone followed by bortezomib, thalidomide, and dexamethasone before autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed multiple myeloma
A staged approach with vincristine, adriamycin, and dexamethasone followed by bortezomib, thalidomide, and dexamethasone before autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed multiple myeloma
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DOI：
10.1007/s00277-010-0959-4
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发表时间：
2010-10-01
影响因子：
3.5
通讯作者：
Kwong, Y. L.
中科院分区：
文献类型：
--
作者：
Chim, C. S.;Lie, A. K. W.;Kwong, Y. L.
以硼替佐米为基础的方案对多发性骨髓瘤(MM)有显著的疗效。在这项研究中，我们用分期的方法测试了新诊断的多发性骨髓瘤患者接受长春新碱/阿霉素/地塞米松(VAD)治疗的疗效。对VAD敏感的患者(减少75%的副蛋白)接受自体造血干细胞移植(Auto-HSCT)，而对VAD不敏感的患者(减少75%的副蛋白)在接受自体造血干细胞移植之前接受进一步的细胞减少治疗。在意向治疗分析中，观察到完全缓解(CR)率逐渐增加，HSCT后累积CR率为48%。七名患者病情恶化，导致三人死亡，其中两人患有中枢神经系统疾病。3年总生存率为75.1%，无事件生存率为48.3%。6名患者发生了与新的副蛋白的寡克隆性重组。在没有抗凝剂预防的情况下，患者没有发生深静脉血栓形成。分期应用VAD+/-VTD/AUTO-HSCT有效率较高，存活率较高。我们的方法在不影响最终CR率的情况下减少了Bortezomib的使用，对不太富裕的社区具有财务意义。
Bortezomib-based regimens have significant activities in multiple myeloma (MM). In this study, we tested the efficacy of a total therapy with a staged approach where newly diagnosed MM patients received vincristine/adriamycin/dexamethsone (VAD). VAD-sensitive patients (a parts per thousand yen75% paraprotein reduction) received autologous hematopoietic stem cell transplantation (auto-HSCT), whereas less VAD-sensitive patients (< 75% paraprotein reduction) received bortezomib/thalidomide/dexamethasone (VTD) for further cytoreduction prior to auto-HSCT. On an intention-to-treat analysis, a progressive increase of complete remission (CR) rates was observed, with cumulative CR rates of 48% after HSCT. Seven patients progressed leading to three fatalities, of which two had central nervous system disease. The 3-year overall survival and event-free survival were 75.1% and 48.3%, respectively. Six patients developed oligoclonal reconstitution with new paraproteins. In the absence of anticoagulant prophylaxis, no patients developed deep vein thrombosis. The staged application of VAD+/-VTD/auto-HSCT resulted in an appreciable response rate and promising survivals. Our approach reduced the use of bortezomib without compromising the ultimate CR rate and is of financial significance for less affluent communities.