Bortezomib-based induction improves progression-free survival of myeloma patients harboring 17p deletion and/or t(4;14) and overcomes their adverse prognosis
Bortezomib-based induction improves progression-free survival of myeloma patients harboring 17p deletion and/or t(4;14) and overcomes their adverse prognosis
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DOI：
10.1007/s00277-016-2692-0
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发表时间：
2016-05
影响因子：
3.5
通讯作者：
A. El-Ghammaz;Essam Abdelwahed
中科院分区：
文献类型：
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作者：
A. El-Ghammaz;Essam Abdelwahed
提供一种适应风险的治疗策略一直是正在进行的旨在提供针对个体遗传组成的治疗的研究工作的一个关键目标。用荧光原位杂交（FISH）检测了80例骨髓瘤患者的17 p缺失和/或t（4;14）。根据FISH结果，它们被分为缺乏它们的患者（标准风险）和携带它们的患者（高风险）。将每类患者按1：1随机分配至长春新碱、阿霉素和地塞米松（VAD）或硼替佐米和地塞米松（VD）诱导治疗组，随后进行自体干细胞移植和沙利度胺维持治疗，并随访32个月。32.5%的患者为高风险。诱导后，标准和高风险患者中VD组至少达到非常好的部分缓解的比率显著较高。在标准和高风险患者中，VAD组和VD组之间的完全缓解率差异不显著。中位随访17.5个月后，标准和高风险患者中VAD和VD组的总生存期（OS）无显著差异。在标准和高风险患者中，VD组的无进展生存期（PFS）上级。在接受VD治疗的患者中，属于标准和高风险组的患者具有相似的PFS。总之，在改善PFS而非OS方面，在携带17 p缺失和/或t（4;14）的患者中，基于硼替佐米的诱导上级基于非硼替佐米的诱导。此外，它降低了携带这些高风险细胞遗传学的患者的进展风险。
Providing a risk-adapted treatment strategy has been a key goal in the ongoing research efforts aimed at providing treatment tailored to the individual genetic make-up. Eighty myeloma patients have been tested for presence of 17p deletion and/or t(4;14) by fluorescent in situ hybridization (FISH). Based on FISH results, they have been categorized into patients lacking them (standard risk) and those harboring them (high risk). Patients in each category were randomly assigned 1:1 to induction treatment by either vincristine, adriamycin and dexamethasone (VAD), or bortezomib and dexamethasone (VD) followed by autologous stem cell transplantation and thalidomide maintenance and were followed up for 32 months. 32.5 % of patients were high risk. Following induction, there were significantly higher rates of at least very good partial response achievement in VD arms in standard- and high-risk patients. Regarding complete response achievement, there were insignificant differences between VAD and VD arms in standard and high-risk patients. After a median follow-up of 17.5 months, there was insignificant difference in overall survival (OS) between VAD and VD arms in standard and high-risk patients. There was superior progression-free survival (PFS) in VD arms in standard- and high-risk patients. Among patients who received VD, those belonging to standard and high-risk groups had similar PFS. In conclusion, bortezomib-based induction is superior to non-bortezomib-based one in patients harboring 17p deletion and/or t(4;14) in terms of improving PFS but not OS. Also, it reduces progression risk in patients harboring these high risk cytogenetics.