大剂量化疗联合自体造血干细胞移植为新诊断多发性骨髓瘤的标准治疗方案。治疗前硼替佐米+沙利度胺+地塞米松（VTD)与硼替佐米+地塞米松+环磷酰胺（VCD）作诱导方案，那个更有优势？最近发表于《BLOOD》杂志的一项回顾性研究表明：在经过4个疗程的诱导治疗后，达到非常好部分缓解率为VTD和VCD组分别为66.3%和56.2%（P = 0.05），总体反应率为分别为92.3%与83.4%（P = 0.01）。VCD组较VTD组，有更高的血液学毒性发生，如3级和4级的贫血、血小板减少和中性粒细胞减少。但VTD组较VCD组，有更多的患者发生的周围神经病变（PN）。除外血液系统不良事件和周围神经病变，其他的3级或4级毒性是罕见的。该研究表明，在新诊断的多发性骨髓瘤自体造血干细胞移植前，可使用VTD作为诱导治疗方案。
Blood. 2016 Mar 21. pii: blood-2016-01-693580. [Epub ahead of print]
The Intergroupe Francophone du Myelome conducted a randomized trial to compare bortezomib-thalidomide-dexamethasone (VTD) to bortezomib-cyclophosphamide-dexamethasone (VCD) as induction before high-dose therapy and autologous stem cell transplantation (ASCT) in patients with newly diagnosed multiple myeloma. Overall, a total of 340 patients were centrally randomly assigned to receive VTD or VCD. After 4 cycles, on an intent-to-treat basis, 66.3% of the patients in the VTD arm achieved at least a very good partial response (primary end-point) versus 56.2% in the VCD arm (p = 0.05). In addition, the overall response rate was significantly higher in the VTD arm, 92.3% versus 83.4% in the VCD arm (p = 0.01). Hematologic toxicity was higher in the VCD arm, with significantly increased rates of grade 3 and 4 anemia, thrombocytopenia and neutropenia. On the other hand, the rate of peripheral neuropathy (PN) was significantly higher in the VTD arm. With the exception of hematologic adverse events and PN, other grade 3 or 4 toxicities were rare, with no significant differences between the VTD and VCD arms. Our data support the preferential use of VTD rather than VCD in preparation for ASCT. This study was registered at www.clinicaltrials.gov as #NCT01564537 and EudraCT as #2013- 003174-27.
Copyright © 2016 American Society of Hematology.