RESUMO
Objective To evaluate the efficacy of PAD regimen (bortezomib, doxorubicin, dexamethasone) and VAD-like T regimen (vincristine, doxorubicin/doxorubicin derivatives, dexamethasone combined with thalidomide) in the treatment of patients with newly diagnosed multiple myeloma (MM). Methods The efficacy of 54 patients with MM who received VAD like-T regimen and 72 patients with MM who were treated with PAD regimen, including complete remission (CR) rate, very good partial remission (VGPR) rate, overall response rate (ORR), overall survival (OS), progression-free survival (PFS) and adverse events, were retrospectively analyzed. Results The CR rate of PAD group was higher than that of VAD-like T group [31.5 % (23/72) vs. 9.3 % (5/54), χ2=0.30, P=0.002]. The VGPR rate and ORR of PAD group were not statistically higher than those of VAD-like T group [16.7 % (12/72) vs. 16.6 % (9/54), P=0.180; 82.2 %(65/72) vs. 81.5 % (44/54), P=0.190, respectively]. Median PFS of PAD group was significant longer than that of VAD-like T group [(38.2±2.2) months vs. (28.0±7.6) months, P=0.017]. The 3- and 5-year OS rates of PAD group were higher than those of VAD-like T group, but there were no significant differences between two groups (P>0.05). In terms of the adverse events, the incidence of peripheral neuropathy in PAD group was significantly higher than that of VAD-like T group [31.5 % (23/72) vs. 14.5 % (8/54), P=0.03]. Conclusions Compared with PAD protocol, the CR and median PFS of VAD-like T regimen are poor, however, VGPR,ORR, PFS and 5-year OS are similar between the two groups, and VAD-like T regimen is safer with low incidence of peripheral neuropathy. VAD-like T regimen as the first-line treatment is effective and well-tolerated, especially for newly diagnosed MM patients not suitable for transplantation and bortezomib.
RESUMO
Objective Bortezomib plus dexamethasone (BD) and bortezomib,epirubicin plus dexamethasone (PAD) are both front-line regimens of multiple myeloma.This study aimed to assess the efficacy and safety of BD versus PAD regimens in multiple myeloma.Methods All 208 patients with newly diagnosed multiple myeloma using either BD or PAD front-line regimens were enrolled between November 2006 and July 2014.Front-line chemotherapy regimens were 2-7 cycles.Response rates,overall survival,progression-free survival,and adverse effects were retrospectively analyzed.Results (1) In PAD group,the overall response rate was 82.9％ [complete response(CR) 28.6％,very good partial response(VGPR) 12.9％],which was similar as that in BD group [70.3％ (CR 26.8％,VGPR 5.1％),P =0.049].The estimated median progression-free survival was 34.0 months in PAD group versus 25.0 months in BD group (P =0.010).(2) The triplet regimen has a higher accumulated response rate along with chemotherapy cycles,but it didn't show any difference with the doublet regimen.(3) In elderly patients (＞ 65 years old),the overall response rates in two groups had no significant difference (P =0.769),while in patients ≤65 years old,PAD regimen were more effective than BD regimen (P =0.037).(4) Grade 3 and 4 adverse events were recorded with a higher number of patients in the PAD group than those in the BD group.Conclusions Compared with BD regimen,PAD regimen improves the initial response rates,especially deep responses,as well as progression-free survival in patients with newly diagnosed multiple myeloma.However,more severe toxicities are accordingly higher.In elderly patients,overall response rate,estimated median progression-free survival,and median overall survival are all comparable in both regimens.