初诊多发性骨髓瘤治疗进展技巧.ppt

UPFRONT 研究：VD vs VTD vs VMP 初治不适合移植的骨髓瘤患者随机入3个试验组 入选患者疾病标准: 症状性骨髓瘤, 可测量病变 1° R A N D O M I Z A T I O N VD 8 *21-day courses V 1.3 mg/m2, d 1, 4, 8, 11; D 20 mg, d 1, 2, 4, 5, 8, 9, 11, 12 [cycles 1–4]), d 1, 2, 4, 5 [cycles 5–8] VTD 8* 21-day courses V as before; T 100 mg/day, d 1–21; D as before VMP 8 21-day courses V as before; M 9 mg/m2 ; d 1–4 every other cycle P 60 mg/m2, d 1–4 every other cycle MAINTENANCE five 35-day cycles weekly V 1.6 mg/m2, d 1, 8, 15, 22. The primary endpoint:PFS Ruben Niesvizky, et al.Blood 2013 122:1966 ORR:VD 73% VTD 80% VMP70% CR/nCR 率：VTD(40%)略高于 VMP(32%)/VD(30%) VTD (PN) 的毒性大于VMP PFS和OS：3组无差异 Considering efficacy and safety, VMP better than VTD for elderly MM patients Nesvzky R ASH 2013 Abstract 1966 UPFRONT研究:结果 OS VD14.7个月 VTD15.4个月 VMP 17.3个月 (VMP) VD49.8个月 VTD51.5个月 VMP 53.1个月 (VMP) * 分组：年龄 (≤ 75岁 vs 75岁)、国家和ISS分期(I或II vs III) 强制抗血栓处理 FIRST, Frontline Investigation of Revlimid and Dexamethasone versus Standard Thalidomide; ISS, International Staging System; LEN, lenalidomide; LoDEX, low-dose dexamethasone; LT, long-term; MEL, melphalan; MM, multiple myeloma; MPT, melphalan, prednisone, thalidomide; OS, overall survival; PD, progressive disease; PFS, progression-free survival; Pred, prednisone; pt, patient; Rd, lenalidomide plus low-dose dexamethasone; Rd18, lenalidomide plus low-dose dexamethasone for 18 cycles; THAL, thalidomide; Tx, treatment. Benboubker L, et al. N Engl J Med. 2014;371:906-917. FIRST/MM020研究: 研究设计 aComplete cytogenetics profile for 762 pts (248 in continuous Rd, 261 in Rd18, and 253 in MPT); high-risk defined as t(4;14), t(14;16), or del(17p). CrCl, creatinine clearance; ECOG PS, Eastern Cooperative Oncology Group performance status; FIRST, Frontline Investigation of Revlimid and Dexamethasone versus Standard Thalidomide; ISS, International Staging System; MPT, melphalan, prednisone, thalidomide; pt, patient; Rd, lenalidomide plus low-dose dexamethasone; Rd18, lenalidomide