RVD方案治疗老年高危多发性骨髓瘤临床观察

Clinical observation of RVD regimen in the treatment of elderly patients with high-risk multiple myeloma

目的探讨RVD(来那度胺、硼替佐米联合地塞米松)方案治疗老年高危多发性骨髓瘤患者MM的疗效及安全性。方法选取2017年2月至2020年2月在我院治疗的24例老年高危(Multiple myeloma,MM)患者为研究对象,依据化疗剂量的不同分为全剂量组和减低剂量组;依据是否携带有高危遗传学异常(High risk cytogenetic abnormality,HRCA)分为HRCA组和非HRCA组。患者均治疗4个疗程后比较总体反应率(Overall response rate,ORR),观察RVD方案的安全性。中位随访17.2个月后,比较无进展生存(Progression-free survival,PFS)及总生存(Overall survival,OS)时间。结果全剂量组ORR为81.8%,高于减低剂量组的53.8%,两组比较,差异有统计学意义(P=0.040);非HRCA组ORR高于HRCA组,两组比较,差异有统计学意义(P=0.002)。HRCA组的中位PFS为10.3个月,明显低于非HRCA组的17.3个月,差异有统计学意义(P=0.047);全剂量组的中位PFS为12.1个月,与减低剂量组比较,差异无统计学意义(P=0.791)。HRCA组中位OS为16.3个月,非HRCA组中位OS未达到,差异无统计学意义(P=0.129)。减低剂量组中位OS为29.4个月,全剂量组中位OS未达到,两组比较,差异有统计学意义(P=0.518)。RVD方案的最常见非血液学不良反应为周围神经炎,发生率为29.2%。血液学不良反应主要为中性粒细胞减少,发生率为12.5%。结论HRCA是影响疗效及预后的重要因素,RVD方案治疗老年高危MM具有良好疗效及安全性,减低剂量亦可取得满意疗效。

Objective To explore the efficacy and safety of RVD regimen(lenalidomide,bortezomib combined with dexamethasone)in the treatment of elderly patients with high-risk multiple myeloma(MM).Methods Twenty-four elderly patients with high-risk multiple myeloma treated in our hospital from February 2017 to February 2020 were selected as research subjects,and were divided into the full dose group and the reduced dose group according to the chemotherapy dose.They were divided into the HRCA group and the non-HRCA group according to whether carrying high risk cytogenetic abnormality(HRCA).The overall response rate(ORR)after 4 cycles of chemotherapy were compared,and the safety of RVD regimen were observed.After median follow-up of 17.2 months,the progression-free survival(PFS)and the overall survival(OS)were compared.Results The ORR in the full dose group(81.8%)was higher than that in the reduced dose group(53.8%),with statistically significant difference(P=0.040).The ORR in the non-HRCA group was higher than that in the HRCA group,with statistically significant difference(P=0.002).The PFS in the HRCA group(10.3 months)was significantly lower than that in the non-HRCA group(17.3 months),with statistically significant difference(P=0.047).There was no statistically significant difference in the PFS between the full dose group(12.1 months)and the reduced dose group(P=0.791).There was no statistically significant difference in the median OS between the HRCA group(16.3 months)and the non-HRCA group(not reaching the median OS)(P=0.129).There was no statistically significant difference in the median OS between the reduced dose group(29.4 months)and the full dose group(not reaching the median OS)(P=0.518).The most common adverse reaction of RVD regimen was peripheral neuritis,with an incidence rate of 29.2%.The main hematological adverse reaction was neutropenia,with an incidence rate of 12.5%.Conclusion HRCA is an important factor affecting the efficacy and prognosis.RVD regimen has good efficacy and safety in the treatment of elderly patients with high-risk multiple myeloma,and the satisfactory efficacy can be achieved by the reduced dose.