BCD方案不同疗程数对于初治多发性骨髓瘤的疗效影响

Therapeutic effects of number of BCD(bortezomib, cyclophosphamide, dexamethasone) chemotherapy courses on newly diagnosed multiple myeloma

目的:分析2、4、6个疗程以硼替佐米(bortezomib)为基础的3药联合诱导,包括硼替佐米、环磷酰胺(cyclophosphamide)、地塞米松(dexamethasone)即BCD方案3药联合治疗初治多发性骨髓瘤(multiple myeloma,MM)的疗效。方法:回顾性分析2014年1月1日至2016年7月30日北京大学人民医院初诊MM一线采用BCD的3药方案治疗≥2个疗程、随访资料完整、不合并髓外浆细胞瘤及淀粉样变性的70例患者的临床资料。统计单纯接受2、4、6个疗程患者疾病治疗疗效。结果:70例患者中,男女比为36∶34。中位年龄为58.4(33～81)岁,ISS分期Ⅰ、Ⅱ、Ⅱ期分别为16、18、36例。单纯接受2、4、6个疗程BCD患者分别为14、20、36例。仅接受2个疗程组中完全缓解(complete response,CR)、≥非常好的部分缓解(very good partial response,VGPR)、≥部分缓解(partial response,PR)比例分别为14.28%、42.86%和71.42%;仅接受4个疗程组中CR、≥VGPR、≥PR比例分别为30.00%、60.00%和80.00%;仅接受6个疗程组中CR、≥VGPR、≥PR比例分别为38.89%、75.00%和83.33%。中位随访时间为15.37(2～32)个月,预估中位无进展生存期(median progression free survival,mPFS)为21.96(95%CI:19.26～24.70)个月。3组无进展生存期(progression free survival,PFS)差异无统计学意义(P=0.700)。结论:BCD方案3药联合治疗中,最大疗效发生在4个疗程及以后。随着诱导疗程数的进一步增加,疾病缓解程度增加,但总体缓解率提高不明显。一线诱导治疗初诊MM可采用BCD方案4个疗程及以上。

Objective： To analyze the treatment effect of the number of bortezomib, cyclophosphamide, and dexamethasone （BCD） chemotherapy courses for newly diagnosed multiple myeloma. Methods： We retrospectively analyzed data of patients with newly diagnosed multiple myeloma from January 2014 to July 2016 in Peking University People＇s Hospital. All 70 patients received two or more courses of BCD chemotherapy. Patients with extramedullary disease or amyloidosis were excluded. Patients completed their follow-up, and the treatment effects were studied in those who only received two, four, and six chemotherapy courses. Results： Among the 70 patients, the ratio of male to female was 36：34, the median age of disease onset was 58.4 y （range： 33-81y）, and the number of patients with ISS stages Ⅰ, Ⅱ, and Ⅲ was 26, 28, and 36, respectively. The number of patients who received two, four, and six chemotherapy courses was 14, 20, and 36, respectively. The percentages of complete remission, equal or more than very good partial remission, equal or more than partial remission for patients who received two courses were 24.28%, 42.86%, and 72.42%, those for four courses were 30.00%, 60.00%, 80.00%, and those for six courses were 38.89%, 75.00%, 83.33%, respectively. During the median 25.37 （range： 2-32） months follow up, the estimated progression free survival （PFS） was 21.96 months （95% CI： 19.26-24.70）. No statistically significant difference for PFS was observed among the three groups （P=0.700）. Conclusions： For the BCD chemotherapy regimen, the maximum therapeutic effect occurred after four or more courses. As the number of induction courses after four chemotherapies increased, the depth of disease relief increased but overall remission did not show substantial improvement. Therefore, four or more BCD chemotherapies can be used for the first line of induction therapy.