内科理论与实践 ›› 2023, Vol. 18 ›› Issue (03): 165-170.doi: 10.16138/j.1673-6087.2023.03.006
收稿日期:
2023-03-18
出版日期:
2023-06-30
发布日期:
2023-08-07
通讯作者:
刘元昉 E-mail: 基金资助:
WANG Yan, TAO Yi, JIN Shiwei, MI Jianqing, LIU Yuanfang()
Received:
2023-03-18
Online:
2023-06-30
Published:
2023-08-07
摘要:
目的: 探索调整剂量的达妥木单抗联合地塞米松、环磷酰胺、依托泊苷、顺铂(dose adjustment daratumumab with dexamethasone, cyclophosphamide, etoposide, cisplatin,DA-DDCEP)方案治疗硼替佐米和来那度胺双耐药的多发性骨髓瘤(multiple myeloma, MM)患者的疗效和安全性。方法: 回顾性收集2020年3月至2022年9月,本院血液科接受DA-DDCEP方案治疗的硼替佐米和来那度胺双耐药的MM患者共17例。统计分析治疗的总反应率(overall response rate, ORR)、最佳缓解率、无进展生存(progression-free survival,PFS)和总生存(overall survival,OS)时间,探讨治疗后反应、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体能状态、是否伴髓外病变对生存的影响。收集治疗相关的血液学及非血液学毒性发生情况。结果: 17例患者平均年龄(63.2±10.0)岁,男性8例(47%),中位治疗线数5(3~8)线。经过中位4(2~14)个疗程,患者ORR为 65%,其中完全缓解(complete response,CR)率 18%。中位随访26(11~40)个月,中位PFS期和OS期分别为8个月和12个月。治疗后是否取得治疗反应,对生存有显著影响,达PR及以上疗效和无治疗反应的PFS期分别为14个月和2个月(P=0.000),OS期分别为19个月和7个月(P=0.05)。ECOG体能状态对生存影响不大,ECOG评分≤2分和>2分的中位PFS期和OS期分别为8个月比7个月(P=0.863)和19个月比10个月(P=0.615)。复发伴髓外病变和不伴髓外病变的PFS期和OS期分别6个月比14个月(P=0.009)和9个月比19个月(P=0.187)。3~4级的不良反应包括中性粒细胞减少8例(47%)、贫血8例(47%)、淋巴细胞减少9例(53%)、血小板减少9例(53%)。肺部感染5例(29%),均为2级, 2例患者发生乙型肝炎(乙肝)再激活。结论: DA-DDCEP方案治疗硼替佐米和来那度胺双耐药的复发MM患者有效。ECOG体能状态较差的患者能耐受并可获益,复发伴髓外病变患者的生存仍有待提高。整体安全性良好,需注意监测乙肝病毒。
中图分类号:
王焰, 陶怡, 金诗炜, 糜坚青, 刘元昉. 调整剂量的达妥木单抗联合DCEP治疗硼替佐米和来那度胺双耐药的多发性骨髓瘤[J]. 内科理论与实践, 2023, 18(03): 165-170.
WANG Yan, TAO Yi, JIN Shiwei, MI Jianqing, LIU Yuanfang. Dose-adjusted daratumumab combined with DCEP in treatment of multiple myeloma dual-refractory to bortezomib and lenalidomide[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(03): 165-170.
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