Clinical Effects Of Modified VDT Regimen In The Treatment Of Multiple Myeloma

Objective To compare retrospectively the clinical effects and adverse reactions of modified VDT regimen vs traditional VDT regimen in the patients of newly diagnosed mulitiple myeloma(NDMM)and of relapsed/refractory multiple myeloma(RRMM).Methods To collect the patients of newly diagnosed mulitiple myeloma(NDMM)and of relapsed/refractory mulitiple myeloma(RRMM)from September 2013 to May 2017 at The Affiliated Hospital of Qingdao University.All patients met the diagnostic criteria set by the 2014 International Myeloma Working Group(IMWG).In total,82 patients were enrolled,including 48 males and 34 females,aged 27-82 years,sixty-five cases were NDMM,seventeen cases were RRMM.Twenty-six patients received traditinal VDT regimen:consisting of bortezomib 1.3 mg/m2 administered subcutaneously on days 1,4,8,and 11,dexamethasone 40 mg administered orally on days1-2,4-5,8-9 and days 11-12 plus thalidomide 100 mg/day administered orally,every 28 days is one cycle.Fifty-six patients received modified VDT regimen:the first two cycles are same as traditional VDT regimen,after two cycles,recieved bortezomib 1.3 mg/m2 administered subcutaneous injection on days 1,8,15,and 22,dexamethasone and thalidomide adminstered as same as traditional one.The clinical effects refers to the 2014 IMWG effect evaluation criteria.The safety assessment refers to the Common Terminology Criteria for Adverse Events(CTCAE)version 4.0 published by NCI.Data processing used SPSS 17.0 statistical software for processing.The clinical characteristics and effects were tested with the Pearson χ2 test.When correction were needed,the χ2 test continuous correction formula was used,Kaplan-Meier method was used for survival analysis.P<0.05 was statistically significant.Results 1.Response to two therapy groups of patients received treatment after 4 cycles were evaluated.In traditional group of 26 patients,the overall response rate(CR+VGPR+PR)was 84.6%(22/26).In modified group of 56 patients,the overall response rate(CR+VGPR+PR)was 82.1%(46/56).There was no statistically difference between two groups(P>0.05).2.The efficacy of newly diagnosed and relapsed/refractory patients were analyzed.In newly diagnosed patients,the overall response rate(CR+VGPR+PR)of 20 cases in traditional group was 90.0%(18/20).Forty-five cases in modified group,and the overall response rate(CR+VGPR+PR)was 86.6%(39/45).There was no statistically significant between two groups(P>0.05).In relapsed/refractory patients,the overall response rate(CR+VGPR+PR)of 6 cases in traditional group was 66.6%(4/6).Eleven cases in modified group,and the overall response rate(CR+VGPR+PR)was 63.6%(7/11).There was no statistically significant between two groups(P>0.05).3.Compared with the traditional group,the incidence of anemia,neutropenia,thrombocytopenia,infection,thrombosis,gastrointestinal reactions,fatigue,and heart disease in the modified group was not statistically different(P> 0.05).The incidence of peripheral neuropathy(PN)in modified group was lower than that in traditional group.The difference was statistically significan(P?0.05).4.Follow-up for 3-36 months was performed in both groups with a median follow-up of 19.5 months.The median PFS in traditional group was 21 months(3-33 months),and the median PFS in modified group was 19 months(4-36 months).Log-rank test P> 0.05(P=0.892),the difference was not statistically significant.The median OS of traditional group was 23 months(3-36 months),and the median OS of modified group was 20 months(4-36 months).The survival curve of the two groups was compared,Log-rank test P>0.05(P=0.524),the difference was not statistically significant.Conclusion Compared with traditional VDT regimen in the treatment of multiple myeloma,modified VDT regimen has the same effects and less side effects,especially improving the side effects of peripheral neuropathy.Therefore making it easier for patients to receive treatment.