| BackgroundMultiple myeloma（MM）is a kind of clonal plasma cell abnormal proliferative malignant tumor,which occurs in middle-aged and elderly people.Male is more than female,accounting for the second place in hematological malignant tumor,second only to lymphoma.The incidence rate accounts for 1%of all human malignancies and is still incurable[1].With more than a decade,lenalidomide,bortezomib and other drugs have been used in clinical practice,and MM patients have achieved higher efficiency and longer survival.Bortezomib is now widely used in the initial treatment,refractory/recurrence,and maintenance treatment of multiple myeloma and pretreatment before stem cell transplantation,which is significantly better than traditional drug therapy[2,3].A single-center retrospective study found that the PFS and OS containing the bortezomib regimen were significantly higher than the bortezomib-free regimen.Bortezomib is a reversible proteasome inhibitor that exerts anti-tumor effects through multiple pathways[4].ObjectiveTo investigate the efficacy and adverse reactions of three treatment regimens based on bortezomib in the treatment of newly diagnosed multiple myeloma,and to analyze the effects of different treatment regimens on stem cell collection and autologous hematopoietic stem cell transplantation.MethodA total of 259 newly diagnosed MM patients admitted to the Department of Hematology,Zhengzhou University Affiliated Tumor Hospital from June 1,2009 to December 31,2009 were collected.Each patient completed at least 6 cycles of treatment,and some patients underwent autologous hematopoietic stem cell collection and transplantation after 6 cycles.According to the treatment plan,it is divided into:bortezomib,dexamethasone combined with thalidomide（VTD）;bortezomib,dexamethasonecombinedwithcyclophosphamide（VCD）;bortezomib,dexamethasone combined with doxorubicin（VAD）.Retrospective analysis of its clinical characteristics,monitoring of blood routine,urine routine,blood biochemistry and other indicators during the treatment,observe the patient’s adverse reactions,according to the test results and conditions to adjust the drug dose in a timely manner,and treat the disease.Regularly review bone marrow puncture and biopsy.Follow-up of patients’survival by telephone or clinic.To explore the effects of three groups of treatment efficient,adverse reactions,and the number of autologous hematopoietic stem cells collected.Each group was divided into a transplant group/non-transplant group according to whether the patient underwent autologous hematopoietic stem cell transplantation,and the progression-free survival time and total survival time were compared between the transplant group/non-transplant group of each group,non-transplant group of the three groups,and transplant group of the three groups.Results1.The overall response rate（ORR）of VTD group/VCD group/VAD group was70.6%（89/126）,54.7%（47/86）,48.9%（23/47）after 1 cycle of chemotherapy,respectively.The ORR of the VTD group was significantly higher than that of the VCD group and the VAD group（P=0.017,P=0.008）,but there was no significant difference in the ORR between the VCD group and the VAD group（P=0.528）.2.The ORR of VTD group/VCD group/VAD group was 88.8%（112/126）,77.9%（67/86）,76.6%（36/47）after 6 cycles of chemotherapy,and the ORR of VTD group was significantly higher than that of the VCD group and the VAD group（P=0.030,P=0.041）,but there was no significant difference in the ORR between the VCD group and the VAD group（P=0.863）.3.In the VTD group/VCD group/VAD group,the ORR of patients with DS stage II+III after 6 cycles of chemotherapy was 85.8%（91/106）and 72.5%（50/69）,respectively.70.7%（29/41）,the ORR of VTD group was significantly higher than that of VCD group and VAD group,the difference was statistically significant（P=0.029,P=0.034）,but there was no significant difference in ORR between VCD group and VAD group（P=0.845）.4.In terms of adverse reactions,the blood toxicity of the VTD group was significantly lower than that of the VCD group and the VAD group,and the difference was statistically significant.The peripheral neurotoxicity,incidence of pulmonary infection,incidence of urinary tract infection,and incidence of fatigue in the VCD group were significantly lower than those in the VTD group and the VAD group,and the difference was statistically significant.The incidence of herpes zoster in the VAD group was significantly lower than that in the VTD group and the VCD group,and the difference was statistically significant.5.VTD group/VCD group/VAD group received autologous hematopoietic stem cells after 6 cycles of treatment.The median collection of CD34+was 5.15*10^6/kg,5.38*10^6/kg,5.23*10^6/kg,respectively.Not statistically significant（P=0.826）.6.The median follow-up time was 30（1-103）months.The VTD group showed a median PFS of 53 months vs 32 months in the transplant group/non-transplant group,the difference was statistically significant（P=0.032）,median The OS was 66 months vs 52 months,and the difference was not statistically significant（P=0.433）.The VCD group showed that the median PFS was 49 months vs 25 months in the transplant group/non-transplant group,the difference was statistically significant（P=0.016）,and the median OS was 58 months vs 45 months.The difference was not statistically significant（P=0.081）.The VAD group showed that the median PFS of the transplant group/non-transplant group was 49 months vs 30 months,the difference was statistically significant（P=0.037）,and the median OS was 61 months vs 45 months.The difference was not statistically significant（P=0.738）.7.The median PFS of the non-transplant group in the VTD group/VCD group/VAD group was 32 months,25 months,and 30 months,respectively.The difference was not statistically significant（P=0.604）.The median OS was 52 months,45 months,and 45 months,respectively.The difference was not statistically significant（P=0.519）.The median PFS of the transplant group was 53 months,49months,and 49 months,respectively,and the difference was not statistically significant（P=0.108）.The median OS was 66 months,58 months,and 61 months,respectively.The VTD group was significantly higher than the VCD group,and the difference was statistically significant（P=0.009）.Conclusions1.Whether in the first course or after multiple courses,the efficacy of the VTD group is significantly better than that of the VCD group and the VAD group;and for the MM patients with a later stage,the VTD group is significantly better than the other two groups.2.The VTD group has the lowest blood toxicity.The peripheral neurotoxicity,the incidence of pulmonary infection,the incidence of urinary tract infection,and the incidence of fatigue are the lowest in the VCD group,and the incidence of herpes zoster in the VAD group is the lowest.3.The three treatment regimens have no significant effect on the amount of autologous hematopoietic stem cells collected.4.In each treatment group,the PFS of the transplant group is significantly higher than that of the non-transplant group,suggesting that transplantation can improve the prognosis of patients.There is no difference in the impact of the three groups on PFS regardless of whether the patient is undergoing autologous hematopoietic stem cell transplantation. |
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