摘要
目的评价未经自体干细胞移植的具有t(11;14)/CD20^(-)或CD20^(+)特征的多发性骨髓瘤(MM)患者的临床疗效差异性。方法收集2016年至2022年1月于内蒙古医科大学附属医院就诊的95例初诊患者,并纳入开放性临床观察。入组分为:t(11;14)/CD20^(-)或CD20^(+)组和具有其他低危遗传学特征的对照组,3组同时接受硼替佐米为主的诱导和来那度胺为主的巩固/维持治疗。结果t(11;14)/CD20^(-)特征的患者对硼替佐米诱导治疗反应差,3组总缓解率分别为11.1%、84.0%和85.2%(P<0.01);来那度胺能够提高t(11;14)/CD20^(-)患者缓解率,使其与t(11;14)/CD20^(+)和其他低风险组治疗反应率相当(总缓解率分别为77.8%、92.0%和93.4%,P>0.05)。生存分析显示,来那度胺使t(11;14)/CD20^(-)和CD20^(+)以及其他低危风险组的临床生存率差异无统计学意义[4年无进展生存率(PFS)分别为75.0%、77.1%和84.2%,4年总生存率(OS)分别为75.0%、88.5%和90.4%]。含有来那度胺治疗方案所引起的相关不良事件是可耐受的,粒细胞缺乏症、周围神经病变和3/4级感染发生的患者分别为3.2%、8.4%和15.8%。结论对具有t(11,14)/CD20^(-)特征的MM患者,硼替佐米治疗效果不佳,但来那度胺能够进一步提高其PFS和OS,使其和他细胞遗传学低风险的患者,获得相似的远期生存。
Objective To examine the differences in therapy response and confirm the effective regimen for multiple myeloma(MM)patients with t(11;14)/CD20^(-)or CD20^(+),for the selection of transplantation as early treatment.Methods To find the differences in therapy response and to confirm the effective regimen for multiple myeloma(MM)patients with t(11;14)/CD20^(-)or CD20^(+),for the selection of transplantation as the early treatment.There were three cytogenetics groups:t(11;14)/CD20^(-)or CD20^(+)and low-risk profile including normal or cytogenetics other than t(11;14).Eligible patients received the bortezomib-based induction and lenalidomide-based consolidation/maintenance regimen.Results Patients with t(11;14)gained adverse therapy response for bortezomib induction regimen than other low-risk arm(OR rate:11.1%versus 84.0%versus 85.2%,P<0.01).A prospective found that although the patients with t(11;14)/CD20^(-)showed the poor overall response for the bortezomib-based regimen,lenalidomide-based treatment schedule makes them gain a similar therapy advantage comparing with t(11;14)/CD20^(+)and other low-risk group in the study The subgroup analyses of progression-free survival(PFS)and overall survival(OS)by continued lenalidomide-based consolidation/maintenance treatment also showed a benefit for lenalidomide therapy compared with observation regardless of cytogenetic risk profile and response at baseline(PFS at 4 years reached 75.0%versus 77.1%versus 84.2%,OS at 4 years was 75.0%versus 88.5%versus 90.4%,respectively).Moreover,the lenalidomide regimen little induced the incidence of fatal complications and was tolerated.There were only 3.2%,8.4%and 15.8%patients had agranulocytosis,peripheral neuropathy and infection of 3-4 grade.Conclusions Lenalidomide regimen is more effective for t(11,14)/CD20^(-)risk MM and t(11;14)/CD20^(+)and other cytogenetically low-risk MM are consistent in PFS and OS.In addition,the initial response rate of MM patients with unsatisfactory bortezomib treatment can also be improved.
作者
赵卫红
黄彬涛
刘瑞
向彩霞
ZHAO Weihong;HUANG Bintao;LIU Rui;XIANG Caixia(Department of Gastroenterology;Department of Hematology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010059,China)
出处
《基础医学与临床》
2023年第9期1423-1427,共5页
Basic and Clinical Medicine
基金
内蒙古自然科学基金(2019MS08028),内蒙古医科大学面上项目储备基金(YKD2022MS014)。
