Single agent dexamethasone for pre-stem cell transplant induction therapy for multiple myeloma
Single agent dexamethasone for pre-stem cell transplant induction therapy for multiple myeloma
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DOI：
10.1038/sj.bmt.1704633
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发表时间：
2004-09-01
影响因子：
4.8
通讯作者：
Gertz, MA
中科院分区：
文献类型：
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作者：
Kumar, S;Lacy, MQ;Gertz, MA
鉴于生存优势，高剂量治疗（HDT）仍然是符合该程序的多发性骨髓瘤患者的标准治疗。对于接受HDT的患者，在干细胞收获之前给予旨在减少肿瘤负荷的初始治疗。各种方案，主要是VAD（长春新碱、多柔比星、地塞米松）的变化，用于诱导治疗。我们回顾性评估了单药地塞米松是否是一种有效的诱导治疗，因为它是这些组合中最活跃的药物。共35例接受地塞米松单独诱导治疗的患者与72例接受VAD作为初始治疗的相似组进行了比较。我们发现地塞米松的反应率为63%，而VAD为74%（P = 0.25）。包括最小反应，地塞米松和VAD的总反应率分别为74%和86%（P = 0.13）。地塞米松组的移植总体缓解率和完全缓解率分别为97%和26%，VAD组分别为100%和39%; P = 0.33和0.18。移植后1年的无进展生存率和总生存率无显著差异。单药地塞米松似乎是一种有效的替代VAD诱导治疗前HDT骨髓瘤。
Given the survival advantage, high-dose therapy (HDT) remains the standard of care for patients with multiple myeloma eligible for the procedure. For those undergoing HDT, initial therapy aimed at reducing tumor burden is given prior to stem cell harvest. Various regimens, mostly variations of VAD ( vincristine, doxorubicin, dexamethasone), are used for induction therapy. We retrospectively evaluated if single agent dexamethasone would be an effective induction therapy, given that it is the most active drug in these combinations. A total of 35 patients who received induction therapy with dexamethasone alone were compared to a similar group of 72 patients who received VAD as the initial therapy. We found a 63% response rate with dexamethasone compared to 74% with VAD ( P = 0.25). Including minimal responses, the overall response rate for Dex and VAD was 74 and 86%, respectively ( P = 0.13). The overall and complete response rates to transplant, respectively, were 97 and 26% for the dexamethasone group and 100 and 39% for the VAD group; P = 0.33 and 0.18. No significant differences were observed in the progression-free and overall survival at 1 year post transplant. Single agent dexamethasone appears to be an effective alternative to VAD for induction therapy prior to HDT in myeloma.