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目的:比较升阶梯治疗策略和持续新药治疗非移植多发性骨髓瘤(MM)患者的疗效,探讨升阶梯治疗策略是否可以延长非移植MM患者的总生存。方法:回顾性分析102例确诊为MM的非移植患者,其中44例接受升阶梯治疗策略(传统治疗方案-含沙利度胺方案-含硼替佐米方案),58例持续应用新药治疗(含沙利度胺/硼替佐米方案)。分析2组患者的疗效、无进展生存(PFS)和总生存(OS)。结果:一线治疗疗效分析显示,持续新药物组和升阶梯治疗组的总有效率(ORR)和CR+nCR率分别为81%∶57%(P=0.009),50%∶14%(P=0.000);二线治疗疗效显示,持续新药组和升阶梯治疗组的ORR率和CR+nCR率分别为20%∶64%(P=0.027),0∶21%;升阶梯治疗组在三线应用含硼替佐米方案后ORR率可达100%。升阶梯治疗组和持续新药组的PFS1和PFS2分别为17.1∶27.1个月,17.5∶6.5个月,2组的PFS1+PFS2相近。升阶梯治疗组和持续新药组的中位OS分别为43.9和37.1个月。持续新药组一旦复发后的生存期只有10个月,而在升阶梯治疗组可长达26.8个月。结论:升阶梯治疗策略的一线治疗疗效虽然低于持续新药组,但其二线治疗和三线治疗的疗效明显优于持续新药组,且疾病进展后升阶梯治疗组的PFS和OS均优于持续新药治疗。持续新药并不能使非移植MM患者总的PFS和OS获益,反而造成一旦进展后治疗选择难的困境。
OBJECTIVE: To compare the efficacy of ascending-step treatment strategies and continuous neo-drug treatment in non-transplant multiple myeloma (MM) patients and to explore whether the step-up treatment strategy can prolong the overall survival in non-transplant MM patients. Methods: A total of 102 non-transplant MM patients were retrospectively analyzed. Forty-four patients underwent escalating therapy (traditional treatment regimen-thalidomide-bortezomib-containing regimen) and 58 consecutive new drug treatments Thalidomide / bortezomib regimen). The efficacy, progression-free survival (PFS) and overall survival (OS) of the two groups were analyzed. Results: The first-line treatment efficacy analysis showed that the total effective rate (ORR) and CR + nCR rate of the new drug group and the step-up group were 81% and 57% (P = 0.009) and 50% 0.000). The second-line treatment showed that the rates of ORR and CR + nCR were 20%: 64% (P = 0.027) and 0:21% respectively in the new drug group and the ascending group The ORR rate after bortezomib regimen can reach 100%. PFS1 and PFS2 in the ascending-step group and the continuous-new-drug group were 17.1:27.1 and 17.5: 6.5 respectively, and PFS1 and PFS2 in the two groups were similar. The median OS for the ascending and the new drug groups were 43.9 and 37.1 months, respectively. The duration of the new drug group after recurrence was only 10 months, but up to 26.8 months in the ascending group. Conclusion: Although the first-line treatment effect of the ascending-step treatment strategy is lower than that of the continuous new drug group, the second-line and third-line treatment are superior to the continuous new drug group in the first-line treatment and the PFS and OS of the ascending-step treatment group are better than the continuous new drug treatment. Sustained new drugs do not benefit the overall PFS and OS in non-transplant MM patients, but instead lead to the dilemma of treatment options once progression has been achieved.