贾静, 刘爱军, 陈文明, 吴垠, 李燕郴, 冷芸, 高文. RVD方案对新诊断多发性骨髓瘤患者缓解深度的研究[J]. 中国肿瘤临床, 2019, 46(14): 734-738. DOI: 10.3969/j.issn.1000-8179.2019.14.994
引用本文: 贾静, 刘爱军, 陈文明, 吴垠, 李燕郴, 冷芸, 高文. RVD方案对新诊断多发性骨髓瘤患者缓解深度的研究[J]. 中国肿瘤临床, 2019, 46(14): 734-738. DOI: 10.3969/j.issn.1000-8179.2019.14.994
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Jia Jing, Liu Aijun, Chen Wenming, Wu Yin, Li Yanchen, Leng Yun, Gao Wen. A combination of lenalidomide, bortezomib, and dexamethasone (RVD) provides deeper responses in patients with newly diagnosed multiple myeloma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(14): 734-738. DOI: 10.3969/j.issn.1000-8179.2019.14.994
Citation: Jia Jing, Liu Aijun, Chen Wenming, Wu Yin, Li Yanchen, Leng Yun, Gao Wen. A combination of lenalidomide, bortezomib, and dexamethasone (RVD) provides deeper responses in patients with newly diagnosed multiple myeloma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(14): 734-738. DOI: 10.3969/j.issn.1000-8179.2019.14.994
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RVD方案对新诊断多发性骨髓瘤患者缓解深度的研究

A combination of lenalidomide, bortezomib, and dexamethasone (RVD) provides deeper responses in patients with newly diagnosed multiple myeloma

    摘要
  • 摘要:
      目的  分析来那度胺、硼替佐米及地塞米松(lenalidomide，bortezomib and dexamethasone，RVD)方案治疗新诊断多发性骨髓瘤(newly diagnosed multiple myeloma，NDMM)患者的疗效和安全性。
      方法  回顾性分析2015年1月至2019年5月首都医科大学附属北京朝阳医院收治的48例NDMM患者，统计其临床特征及治疗疗效。
      结果  48例患者的中位年龄为59(34~79)岁，DurieSalmon分期Ⅲ期患者44例；ISS分期Ⅱ期患者15例，Ⅲ期患者19例，12例伴浆细胞瘤，细胞遗传学高危患者占32.5%。全部患者接受RVD方案化疗，中位4(1~9)个周期，总有效率97.9%，完全缓解(complete response，CR)率为35.4%，4个周期较2个周期化疗后非常好的部分缓解(very good partial response，VGPR)以上疗效提高为(84.6% vs.64.1%)；平均采集CD34+细胞数4.2(±2.6)×106/kg；诱导治疗后下一代流式微小残留病变(minimal residual disease，MRD)阴性率为20.6%，其中2例移植前MRD阳性者在移植后MRD转阴。治疗过程中2例发生3~4级血液学毒性，未发生3级以上非血液学不良事件。
      结论  采用RVD方案治疗NDMM患者4个疗程，缓解率高，不良反应可耐受，且不影响干细胞采集。RVD诱导联合自体造血干细胞移植可进一步提高MRD阴性率。

     

    Abstract:
      Objective  This study investigated the efficacy and safety of a combination of lenalidomide, bortezomib, and dexamethasone (RVD) in patients with newly diagnosed multiple myeloma (NDMM).
      Methods  The clinical features and responses of 48 patients with NDMM who were treated with RVD from January 2015 to May 2019 in Beijing Chaoyang Hospital were retrospectively analyzed.
      Results  The median age of the 48 patients was 59 years (range:34-79). Among these, 44 patients were Durie-Salmon stage Ⅲ, 15 were ISS stage Ⅱ, 19 were ISS stage Ⅲ, and 12 had plasmacytoma; 32.5% of all patients were cytogenetic high-risk. All patients received a median of four cycles (range:1-9) of the RVD regimen as induction treatment. The overall response rate was 97.9%, with 35.4% of patients achieving complete response (CR) or better. The rate of very good partial remission (VGPR) or better was increased from 64.1% (after two cycles) to 84.6% (after four cycles). The mean collection of CD34+ cells was 4.2 (±2.6)×106/kg. Negative minimal residual disease (MRD), as indicated by next-generation flow (NGF), was achieved in 20.6% of patients after induction. Two patients with positive MRD after induction became MRD negative after transplantation. Two patients developed grade 3 or 4 hematologic toxicity. No nonhematologic toxicity of grade 3 or 4 was observed.
      Conclusions  In patients with NDMM, RVD treatment resulted in significantly improved response rates and exhibited an acceptable risk-benefit profile, with no adverse impact on stem cell collection. RVD combined with transplantation significantly improved the negative rate of MRD, as indicated by NGF.

     

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