CAJ | 학술논문

目的评估沙利度胺与干扰素在多发性骨髓瘤(MM)患者维持治疗的疗效和不良反应.方法回顾性研究接受维持治疗的MM患者57例的无进展生存(PFS)及总生存(0S),并与56例无维持治疗患者比较.结果沙利度胺或干扰素维持治疗均能延长MM患者的PFS率(沙利度胺1、2、3年PFS率为97.4％、82.1％、71.8％比71.4％、44.6％、23.2％；干扰素1、2、3年PFS率为94.4％、83.3％、83.3％比71.4％、44.6％、23.2％)和2、3、4年OS率(沙利度胺为94.9％、92.3％、89.7％比69.6％、42.9％、33.9％；干扰素为94.4％、88.9％、88.9％比69.6％、42.9％、33.9％).沙利度胺可延长IgG型及IgA型的PFS及OS,干扰素可延长IgA型及轻链型的PFS及OS.疗效≥部分缓解(PR)者通过维持治疗可使PFS及OS延长.接受不同诱导和巩固方案患者通过维持治疗均能延长PFS及OS.结论沙利度胺在维持治疗中疗效确切,且不良反应小、使用方便、价廉,推荐沙利度胺作为非轻链型患者的维持治疗.轻链型则建议使用干扰素维持治疗.
목적 평고사리도알여간우소재다발성골수류(MM)환자유지치료적료효화불량반응.방법 회고성연구접수유지치료적MM환자57례적무진전생존(PFS)급총생존(0S),병여56례무유지치료환자비교.결과 사리도알혹간우소유지치료균능연장MM환자적PFS솔(사리도알1、2、3년PFS솔위97.4％、82.1％、71.8％비71.4％、44.6％、23.2％；간우소1、2、3년PFS솔위94.4％、83.3％、83.3％비71.4％、44.6％、23.2％)화2、3、4년OS솔(사리도알위94.9％、92.3％、89.7％비69.6％、42.9％、33.9％；간우소위94.4％、88.9％、88.9％비69.6％、42.9％、33.9％).사리도알가연장IgG형급IgA형적PFS급OS,간우소가연장IgA형급경련형적PFS급OS.료효≥부분완해(PR)자통과유지치료가사PFS급OS연장.접수불동유도화공고방안환자통과유지치료균능연장PFS급OS.결론 사리도알재유지치료중료효학절,차불량반응소、사용방편、개렴,추천사리도알작위비경련형환자적유지치료.경련형칙건의사용간우소유지치료.
Objective To explore the efficacies and toxicities in multiple myeloma (MM) patients on the maintenance therapies of thalidomide and interferon-α so as to seek the optimal chemotherapeutic regimen.Methods A retrospective analysis was conducted for 57 MM patients on the maintenance therapies of thalidomide and interferon-α after introduction and consolidation.And 56 MM patients without maintenance therapy were enrolled as the control group.Results The values of progression-free survival (PFS) and overall survival (OS) were significantly longer in the maintenance group and this translated into an improved estimated 3-year PFS of 75.4％ (71.8％,83.3％ ) versus 23.2％ in the control group ( P ＜ 0.01 ).The estimated 4-year OS was higher in the maintenance group [ 89.5％ ( 89.7％,88.9％ ) vs 33.9％,P ＜ 0.01 ].No statistically significant differences existed among different maintenance groups in terms of PFS and OS.The administration of maintenance therapy extended both PFS and OS for MM patients of various M-proteins (P ＜0.05).However,in the thalidomide group,PFS and OS were extended only in MM of immunoglobulin G (IgG) and immunoglobulin A (IgA) but not in light-chain patients.Furthermore,the MM patients of Durie-Salmon (DS) stages Ⅱ and Ⅲ and international staging system (ISS) stages Ⅱ and Ⅲ extended PFS and OS through maintenance ( P ＜ 0.05 ). While in those of ISS stage Ⅰ,the differences were insignificant in terms of PFS and OS between two groups.The results were similar between the thalidomide and control groups.The patients achieving a partial remission (PR) or higher response level benefited from the maintenance therapy in terms of PFS and OS (P ＜ 0.05 ).In the thalidomide group,the patients with below PR prolonged OS( P =0.031 )but did not achieve a longer PFS( P =0.091 ).Both PFS and OS were extended through maintenance therapy after either stem cell transplantation or consolidation chemotherapies(P ＜ 0.05).There was no significant difference in terms of PFS and OS between MM patients without maintenance therapy after transplantation and those without transplantation. The adverse effects of thalidomide,milder than those of interferon-α,could be tolerated in most patients.The incidence and severity of adverse effects showed no significant difference between the combination maintenance and single agent therapies. Conclusion The maintenance therapies of thalidomide and interferon-α could improve the profiles of PFS and OS in MM patients.And there was no significant difference between them in terms of PFS and OS. However,the maintenance therapy of thalidomide is a better option due to its convenient application,milder adverse effects,reasonable cost and better efficacies in MM patients not achieving PR or receiving induction therapy without bortezomib or without transplantation.