Treatment Of Relapsed Multiple Myeloma A Retrospective Analysis In China

Objective:This study is a single center retrospective analysis designed to assess the efficacy and tolerability of different treatment regimens in patients with multiple myeloma first relapsed. The association between patients’ clinical features and outcome is also observed.Methods:We collect and analyze the dates of56MM patients who relapsed after successful initial treatments and received at least once salvage therapy. Among the56patients,21patients received traditional regimens (including MP, VAD, VCD, TAD, TCD, DECP, DTP ACE regimens),31patients received bortezomib-based combination chemotherapy (combined agents including dexamethasone, thalidomide, cyclophosphamide, doxorubicin and melphalan), and4patients received autologous stem cell transplantation (ASCT) as salvage therapies. All patients received a median3courses of treatments.Results:(1) For the52patients who received traditional regimens or bortezomib-based regimens as salvage therapy, the overall response rate (ORR, defined as≥partial response, PR) was73.1%,≥very good partial response (VGPR) rate was42.3%, nearly complete remission or complete remission rate (nCR/CR) was23.1%.Treatment of bortezomib-based regimens is more likely to get≥PR or≥VGPR, OR is respectively18.305(p=0.002),5.217(p=0.035)。 (2) For the52patients who received traditional regimens or bortezomib-based regimens as salvage therapy, the median progression-free survival (PFS) was7.0months, and median overall survival (OS) was19.0months. The median PFS of patients who received traditional regimens and bortezomib-based regimens were4.0months and9.0months respectively. The patients with traditional treatments are more likely to progress (RR=2.755, p=0.013)(3)4patients received ASCT as salvage therapy and had a median PFS of17months. Two patients have already died, whose OS was47months and30months respectively. For the other two patients, with a follow-up of18months and44months respectively, they are all alive.(4) For the34patients who received bortezomib-based regimens as initial treatments, the ORR was67.6%, median PFS was5.0months, and median OS was22.0months. Among the34patients,90%patients who received bortezomib-based treatment again as salvage treatment get≥PR. The ORR of patients with traditional treatments is35.7%. Treatment of bortezomib-based regimens is more likely to get≥PR (OR=15.296, p=0.004). The patients with traditional treatments are more likely to progress (RR=2.918, p=0.028).(5) The main adverse effect of bortezomib-based combination treatment include herpes zoster, peripheral neuropathy, constipation and fatigue. The main adverse effect of traditional combination chemotherapy include bone marrow suppression, infection, nausea and vomiting.(6) Regression analysis showed:patients who received traditional therapy as initial treatment was more likely to get≥VGPR or nCR/CR, OR is respectively10.211(p=0.003) and6.287(p=0.012); Patients with longer course are less likely to progress or die RR is respectively0.754(0.001) and0.808(0.035); Patients with treatment-free time(TFI)>≤6months are more likely to progress,RR=2.573(p=0.009).(7) Of all the56patients,42cases performed conventional cytogenetics detection and11cases perfomed chromosome detection using fluorescence in situ hybridization (FISH) technology.63.6%of patients were detected to have abnormal cytogenetic aberrations by FISH, and only23.1%cytogenetic aberrations were detected by conventional karyotype analysis. The positive rates were of significant difference (p=0.012). The treatment response, PFS and OS of FISH-negative patients show superior to the FISH-positive patients.Conclusions:For relapsed multiple myeloma, regardless of whether previously exposed to bortezomib, bortezomib-based salvage treatments main get significantly higher response rate and longer PFS than traditional regimens, and are well tolerated. Initial treatment strategy、time free interval and the course of treatments associated with the salvage treatment effects. The detection rate of cytogenetic abnormalities by FISH is higher than conventional karyotype detection. Fish detection is important to approach prognostic factors and guide the treatment choice.