初诊多发性骨髓瘤治疗进展ppt课件

once-weekly schedule of bortezomib.
Reeder et al modified the regimen to a once-weekly schedule of bortezomib.
In the study, patients treated with weekly bortezomib achieved responses similar to the twice-weekly schedule (ORR 93% vs.88%, VGPR 60% vs. 61%).
Bortezomib/Doxorubicin/Dexamethasone
A benefit in terms of increased PFS was also observed in patients with deletion of 17p13.
The rate of grade 2 to 4 peripheral neuropathy was higher in those treated with the bortezomib-containing regimen versus VAD (40% vs. 18%).
适合临床试验者，应考虑进入临床试验。
治疗方案
指南推荐
Use of DCEP as consolidation therapy after primary therapy did not have a significant impact on response rates
The incidence of severe adverse events reported was similar between the two groups.
Bortezomib treatment has been associated with an increased incidence of herpes zoster.
peripheral neuropathy and gastrointestinal disturbance can be higher.
NDMM治疗 杨永公
内容提要
诊断（略） 治疗指征 治疗原则 常用方案选择 特殊人群治疗
治疗指征—有症状MM
无症状MM 1)骨髓浆细胞≥ 60%。 2)血或尿轻链（ K和λ）比值≥ 100。 3）MR或Pet-CT显示有一处骨质破坏。
有症状MM 1) CRAB 2)高粘度血症、淀粉样变性、反复感染（
EVOLUTION study, primary treatment with CyBorD demonstrated ORR of 75% (22% CR and 41%
≥VGPR), and one-year PFS rate was 93%.
Bortezomib
Bortezomib-based regimens may be of value in patients with renal failure, and in those with certain adverse cytogenetic features.
The lenalidomide plus dexamethasone arm showed improved CR rate compared to dexamethasone alone(22.1% vs. 3.8%)
Lenalidomide/Dexamethasone
In an open-label trial, 445 newly diagnosed patients wit high-dose or low-dose regimens.
Bortezomib/Thalidomide/Dexamethasone
Cyclophosphamide/Bortezomib /Dexamethasone
Three phase II studies involving newly diagnosed patients with MM (n = 495) have demonstrated high response rates with CyBorD as primary treatment
In addition, they experienced less grade ¾ adverse events (37%/3% vs. 48%/12%)
Lenalidomide/Dexamethasone
SWOG compared dexamethasone single agent with dexamethasone plus lenalidomide for patients newly diagnosed with MM.
2008WHO)
治疗原则
有治疗指征的MM患者应早系统治疗，包括诱导、巩固 治疗（含造血干细胞移植）以及维持治疗。达到MR以 上疗效时可用原方案继续治疗，直到获得最大程度的 缓解，不建议在治疗有效的病人变更治疗方案；未达 到MR患者应变更治疗方案。
适合自体干细胞移植者，应尽量用新药诱导治疗+造血 干细胞移植。避免使用烷化剂和亚硝基脲类药物。
/Dexamethasone
German DSMM XIa study also demonstrated high responses with CyBorD as primary treatment (ORR was 84%; with 74% PR rate and 10% CR rate). High response rates were seen in patientswith unfavorable cytogenetics。
Reeder et al demonstrated an ORR of 88% including a VGPR or greater of 61% and 39% CR/near CR with CyBorD as the primary regimen.
Cyclophosphamide/Bortezomib