文章：

来那度胺维持治疗持续时间对多发性骨髓瘤患者不同挽救治疗方案结局的影响

The Effect of Duration of Lenalidomide Maintenance and Outcomes of Different Salvage Regimens in Patients with Multiple Myeloma (MM)

原文发布日期：2021-09-22

DOI: 10.1038/s41408-021-00548-7

类型: Article

开放获取: 是

英文摘要：

The optimal duration of lenalidomide maintenance post-autologous stem cell transplant (ASCT) in Multiple Myeloma (MM), and choice of therapy at relapse post-maintenance, need further evaluation. This retrospective study assessed outcomes of patients with MM (n = 213) seen at Mayo Clinic, Rochester between 1/1/2005–12/31/2016 who received lenalidomide maintenance post-ASCT. The median PFS was 4 (95% CI: 3.4, 4.5) years from diagnosis of MM; median OS was not reached (5-year OS: 77%). Excluding patients who stopped lenalidomide maintenance within 3 years due to progression on maintenance, ≥3 years of maintenance had a superior 5-year OS of 100% vs. 85% in <3 years (p = 0.011). Median PFS was 7.2 (95% CI: 6, 8.5) years in ≥3 years vs. 4.4 (95% CI: 4.3, 4.5) years in <3 years (p < 0.0001). Lenalidomide refractoriness at first relapse was associated with inferior PFS2 [8.1 (95% CI: 6.4, 9.9) months vs. 19.9 (95% CI: 9.7, 30.2; p = 0.002) months in nonrefractory patients]. At first relapse post-maintenance, median PFS2 was superior with daratumumab-based regimens [18.4 (95% CI: 10.9, 25.9) months] versus regimens without daratumumab [8.9 (95% CI: 5.5, 12.3) months; p = 0.006]. Daratumumab + immunomodulatory drugs had superior median PFS2 compared to daratumumab + bortezomib [NR vs 1 yr (95% CI: 0.5, 1.5); p = 0.004].
 

摘要翻译： 

多发性骨髓瘤患者在自体干细胞移植后，来那度胺维持治疗的最佳持续时间以及维持治疗后复发时的治疗方案选择仍需进一步评估。本研究回顾性分析了2005年1月1日至2016年12月31日期间在梅奥诊所（罗切斯特）接受来那度胺维持治疗的213例多发性骨髓瘤患者结局。从确诊起计算的中位无进展生存期为4年（95% CI: 3.4-4.5年），中位总生存期未达到（5年总生存率：77%）。排除因维持治疗期间进展而在3年内停用来那度胺的患者后，维持治疗≥3年组的5年总生存率达100%，优于<3年组的85%（p=0.011）。≥3年组的中位无进展生存期为7.2年（95% CI: 6-8.5年），显著优于<3年组的4.4年（95% CI: 4.3-4.5年）（p<0.0001）。首次复发时对来那度胺耐药的患者二次无进展生存期更短[8.1个月（95% CI: 6.4-9.9）vs 非耐药患者19.9个月（95% CI: 9.7-30.2）；p=0.002]。在维持治疗后首次复发时，基于达雷妥尤单抗的方案[18.4个月（95% CI: 10.9-25.9）]相较于非达雷妥尤单抗方案[8.9个月（95% CI: 5.5-12.3）]显示出更优的二次无进展生存期（p=0.006）。达雷妥尤单抗联合免疫调节剂方案的中位二次无进展生存期优于达雷妥尤单抗联合硼替佐米方案[未达到 vs 1年（95% CI: 0.5-1.5）；p=0.004]。

原文链接：

The Effect of Duration of Lenalidomide Maintenance and Outcomes of Different Salvage Regimens in Patients with Multiple Myeloma (MM)