文章：

未受累免疫球蛋白在新诊断多发性骨髓瘤诱导治疗期间的变化

Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma

原文发布日期：2017-06-16

DOI: 10.1038/bcj.2017.46

类型: Original Article

开放获取: 是

英文摘要：

Little is known about the impact of multiple myeloma (MM) treatment on uninvolved immunoglobulins (Ig). We identified 448 patients who received high-dose dexamethasone (HD-DEX), lenalidomide and dexamethasone (RD), bortezomib and dexamethasone (VD), bortezomib, cyclophosphamide and dexamethasone (VCD) or bortezomib, lenalidomide and dexamethasone (VRD) for newly diagnosed MM at our institution between 2000 and 2013, and who had available data on absolute lymphocyte count (ALC) and quantitative uninvolved Ig at baseline and at the end of four cycles of therapy. Changes in ALC and uninvolved Ig were significantly different across treatments, with VCD and HD-DEX producing reductions in uninvolved Ig, and RD, VD and VRD leading to increases in uninvolved Ig. In addition, treatment with RD, VD and VRD was independently associated with higher odds of achieving a ⩾25% increase in or normalization of the primary uninvolved Ig on multivariate analysis. Although achievement of a humoral response in the primary uninvolved Ig was associated with a higher odds of achieving VGPR or better after four cycles of therapy, it was not associated with improved overall survival. These data highlight the different mechanisms of action of MM drugs and point toward a possible role for the use of VCD in treating antibody-mediated autoimmune disease.

摘要翻译： 

关于多发性骨髓瘤（MM）治疗对未受累免疫球蛋白（Ig）的影响目前知之甚少。我们选取了2000年至2013年间在本机构接受大剂量地塞米松（HD-DEX）、来那度胺联合地塞米松（RD）、硼替佐米联合地塞米松（VD）、硼替佐米+环磷酰胺+地塞米松（VCD）或硼替佐米+来那度胺+地塞米松（VRD）方案治疗的448例新诊断MM患者，这些患者在基线和四个治疗周期结束时均具有可用的绝对淋巴细胞计数（ALC）及定量未受累Ig数据。不同治疗方案对ALC和未受累Ig的变化影响存在显著差异：VCD和HD-DEX会导致未受累Ig降低，而RD、VD和VRD则使未受累Ig升高。多变量分析显示，采用RD、VD和VRD治疗与主要未受累Ig实现≥25%增长或正常化的更高概率独立相关。尽管主要未受累Ig达到体液反应与四个治疗周期后获得VGPR（非常好的部分缓解）或更佳疗效的概率更高相关，但与总生存期的改善无关。这些数据揭示了多发性骨髓瘤药物的不同作用机制，并提示VCD可能具有治疗抗体介导的自身免疫疾病的潜在价值。

原文链接：

Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma