J Clin Oncol:新确诊的多发性骨髓瘤患者的巩固和维持治疗

2021-09-16 Nebula MedSci原创

采用硼替佐米、来那度胺和地塞米松进行巩固治疗可显著改善新确诊的多发性骨髓瘤患者的 PFS 和缓解深度

随着蛋白酶体抑制剂和免疫调节剂的引入,多发性骨髓瘤(MM)患者的治疗预后得到了显著的改善,缓解率增加,无进展生存期(PFS)和总生存期(OS)均显著延长。

当下需要前瞻性地评估巩固治疗对新确诊的、符合移植条件的 MM(TE-NDMM)患者的作用。近日,国际期刊《临床肿瘤杂志》上新发表的一项研究(EMN02/HOVON95),评估了巩固治疗对这类患者的作用。

EMN02/HOVON95 试验招募了新确诊的、符合移植条件的 TE-NDMM 患者,在诱导和强化治疗后,予以两个疗程的巩固治疗(硼替佐米、来那度胺和地塞米松[VRD])或不予以巩固治疗,再继以来那度胺维持治疗。主要终点是无进展生存期(PFS)。

两组患者的PFS

共 878 位符合要求的患者被随机分至 VRD 巩固组(451 位患者)和非巩固组(427 位)。中位随访了 74.8 个月后,VRD 巩固组患者的根据预处理调整后的中位 PFS 明显更长(59.3 vs 42.9 个月,风险比[HR] 0.81;95% CI 0.68-0.96; P=0.016)。在大多数预定的亚组中都观察到了 PFS 获益,包括修订的国际分期系统 (ISS) 分期、细胞遗传学和既往治疗。修订的 ISS3 分期(HR 2.00;95% CI 1.41-2.86)和 ampl1q(HR 1.67;95% CI 1.37-2.04)都是显著的不良预后因素。

两组患者的维持时间

中位缓解维持时间是 33 个月(四分位范围 13-86个月)。巩固治疗 vs 非巩固治疗组维持治疗前的≥完全缓解(CR)率分别是 34% vs 18%(P<0.001)。截止分析时,巩固治疗组和非巩固治疗组的≥ CR 率分别是 59%和 46%(P<0.001)。在维持治疗前获得完全缓解或非常好的部分缓解的 226 位患者亚组中进行的流式细胞术微小残留病灶分析显示,74%的 VRD 治疗的患者获得了微小残留病灶阴性。VRD 组的毒性可耐受和可控。

两组患者的OS

综上,采用 VRD 进行巩固治疗继以来那度胺维持相比只用来那度胺维持治疗可显著改善新确诊的多发性骨髓瘤患者的 PFS 和缓解深度

原始出处:

Pieter Sonneveld, et al. Consolidation and Maintenance in Newly Diagnosed Multiple Myeloma. Journal of Clinical Oncology. September 14, 2021. https://ascopubs.org/doi/full/10.1200/JCO.21.01045

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    2022-07-20 jml2009
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    2021-10-03 ms3263590422704434

    学习了

    0

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    2021-09-22 ms5000000694005381

    学习了,谢谢!

    0

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    2021-09-17 学医无涯

    了解一下

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1890297, encodeId=8d45189029e0d, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Wed Jul 20 07:53:34 CST 2022, time=2022-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866227, encodeId=30bf186622ea6, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Oct 01 12:53:34 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057244, encodeId=5f40105e2441b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220121/3f330f5120674454867bac0feecc87e2/d9b4fca813a64858890939f98194bcb9.jpg, createdBy=a1292472119, createdName=ms3263590422704434, createdTime=Sun Oct 03 20:32:08 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053903, encodeId=0bdb105390379, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8c6c5474427, createdName=ms5000000694005381, createdTime=Wed Sep 22 20:32:51 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052192, encodeId=188710521920a, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Fri Sep 17 06:16:01 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052654, encodeId=9569105265441, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Thu Sep 16 23:53:34 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052102, encodeId=9854105210292, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=58c55294961, createdName=1487042cm12暂无昵称, createdTime=Thu Sep 16 21:56:11 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-16 anti-cancer

    谢谢梅斯分享这么多精彩信息

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1890297, encodeId=8d45189029e0d, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Wed Jul 20 07:53:34 CST 2022, time=2022-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866227, encodeId=30bf186622ea6, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Oct 01 12:53:34 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057244, encodeId=5f40105e2441b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220121/3f330f5120674454867bac0feecc87e2/d9b4fca813a64858890939f98194bcb9.jpg, createdBy=a1292472119, createdName=ms3263590422704434, createdTime=Sun Oct 03 20:32:08 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053903, encodeId=0bdb105390379, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8c6c5474427, createdName=ms5000000694005381, createdTime=Wed Sep 22 20:32:51 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052192, encodeId=188710521920a, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Fri Sep 17 06:16:01 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052654, encodeId=9569105265441, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Thu Sep 16 23:53:34 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052102, encodeId=9854105210292, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=58c55294961, createdName=1487042cm12暂无昵称, createdTime=Thu Sep 16 21:56:11 CST 2021, time=2021-09-16, status=1, ipAttribution=)]
    2021-09-16 1487042cm12暂无昵称

    学习

    0

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