Clinical Study Of Bortezomib Combined Regimen In The Treatment Of Multiple Myeloma

Objectives:The aim of this study is to indentify the clinical characteristics of multiple myeloma（MM）and to compare the therapeutic response and efficacy of bortezomib-based combination regimens with non-bortezomib-based chemotherapy and the prognostic factors that influence on progression-free survival（PFS）and overall survival（OS）of patients who were newly diagnosed with MM.Methods:142 MM patients who were newly diagnosed with MM and accepted at least2 courses of treatment from February 2012 to August 2015 in Fujian Frovincial Hospital were retrospectively analyzed retrospectively.Patients treated with bortezomib-based combination regimens as inductive treatment were included in the bortezomib group,and those who were treated with non-bortezomib-based chemotherapy as inductive treatment were included in the non-bortezomib group.The diagnosis of all subjects was based on the guidelines for the diagnosis and treatment of multiple myeloma in China that was revised in 2017,and the efficacy of the treatment were assessed according to the criteria of the international myeloma working group（IMWG）.Counting data were analysed by pearson chi-square test and Fisher,s exact test,and Kaplan-Meier survival curve was used for survival analysis,single factor analysis was tested by Log-rank test and multiple-factor analysis was tested by COX proportional hazards model.Results:142 cases of MM patients were analyzed,including 87（61.3%）males and55（38.7%）females,with the ratio of males to females up to about 3:2.The medium age of the whole group was 62 years old（ranged 29-83 years old）,while the peak age of onset was 51-70 years old（62.7%）,the common types of disease were IgG（50.0%）,IgA（20.4%）and the light chain（25.4%）type.International staging system（ISS）scoring:stage I（19.0%）,stage Ⅱ（39.4%）and stage Ⅲ（41.6%）.112（78.9%）of MM patients had acquired osteolytic damage（grade 2-3）when they were first diagnosed.there were 38 cases（26.8%）of hypercalcemia before rectification and 63 cases（44.4%）of hypercalcemia after rectification.The median PFS and OS of 142 cases MM patients were 13.7 and 22.03 months.The PFS of MM patients with D13S319deletion was significantly shortened（12.70 months vs.6.33 months,P=0.031）,which was significantly different,but there was no significant changes in OS（P=0.375）.The median PFS（17.02 months vs.10.97 months,P=0.000）and OS（26.95 months vs.16.42months,P=0.000）were significantly different between bortezomib group and non-bortezomib group.Complete response（CR）rate（30.3%vs.8.9%）and objective response rate（ORR）（94.2%vs.78.6%）in the bortezomib group were both higher than those in the non-bortezomib group,and the difference in CR rate（P=0.03）and ORR（P=0.007）between the two groups was statistically significant.The age,gender,ISS stage,type,serumβ₂-microglobulin（β₂-MG）,hemoglobin,serum creatinine,albumin,globulin,calcium,corrected calcium,LDH,bone disease grade,genetics and other factors of the 86 patients in the bortezomib group were significantly unassociated with the treatment response.Single factor analysis showed that age,gender,ISS stage,type,serumβ₂-MG,hemoglobin,serum creatinine,albumin,globulin,calcium,corrected calcium,LDH,bone disease grade,genetics and other factors had no significant difference in the PFS of the patients.Multivariate analysis suggested that age≥65years and serumβ₂-MG≥5.5umol/L were the independent prognostic factors for OS.Conclusions:Multiple myeloma was mostly common in the middle-aged and elderly men.Patients newly diagnosed of the disease were mainly on stage Ⅱ and Ⅲ in ISS,and commonly accompanied by osteolytic damage.The most frequent types of disease were IgG,IgA and light chain type.Bortezomib-based combination therapy was more effective than non-bortezomib-based chemotherapy in patients with newly diagnosed MM and it could prolong the PFS and OS.Age≥65 years and serumβ₂-MG≥5.5 mg/L were independent prognostic factors for OS in the bortezomib group.The PFS of MM patients with D13S319 deletion was significantly shortened.The detection rate of hypercalcemia in MM patients could be improved by rectification of serum albumin.