上海交通大学学报（医学版）2025，Vol.45Issue(7)：815-822,8.DOI:10.3969/j.issn.1674-8115.2025.07.002
剂量减低的来那度胺/美法仑/醋酸泼尼松方案治疗老年虚弱新诊断多发性骨髓瘤的效果分析
Efficacy analysis in elderly and frail newly diagnosed multiple myeloma patients with dose-reduced lenalidomide/melphalan/prednisone acetate regimens
摘要
Abstract
Objective·To investigate the efficacy and safety of a dose-reduced,all-oral lenalidomide/melphalan/prednisone acetate(RMP)regimen in elderly and frail patients with newly diagnosed multiple myeloma(NDMM).Methods·Elderly and frail NDMM patients who visited the Department of Hematology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,and the Third People's Hospital of Kunshan from April 2018 to March 2024 were retrospectively included.Clinical data and laboratory indicators were collected,and all patients were treated with the RMP regimen.SPSS 27.0 and R software were used for statistical analysis.Independent t-test was applied to normally distributed quantitative data,Mann-Whitney U test to non-normally distributed quantitative data,and x2 test and Fisher's exact probability method to qualitative data.Kaplan-Meier survival curves and Log-rank test were used for survival analysis.Results·Among the 22 elderly and frail NDMM patients treated with RMP,the median age was 76.3(68.4,95.0)years,and the median follow-up time was 25.5 months.The overall response rate(ORR)was 68.2%,and the rate of≥very good partial response(VGPR)was 36.4%.The median progression-free survival(PFS)was 20.53 months.The median PFS in the≤75-year-old group was 25.23(95%CI 12.95‒37.52)months,while in the>75-year-old group it was 18.23(95%CI 14.86‒21.61)months.There was no significant difference between the two groups.The median PFS in the≥partial response(PR)group was 20.67(95%CI 13.57‒27.76)months,and in the<PR group it was 8.53(95%CI 6.48‒10.59)months,with a statistically significant difference(P=0.011).The median number of treatment courses was 11(2,24).The incidence of treatment-related hematological adverse events of all grades was 63.6%,and≥grade 3 hematological adverse events occurred in 18.2%of patients.The most common treatment-related adverse event(TRAE)in hematology was neutropenia(63.6%),of which≥grade 3 neutropenia accounted for 13.6%.Common non-hematological TRAEs included fatigue(22.7%),respiratory tract infections(18.2%),rash(18.2%),gastrointestinal reactions(18.2%),and thrombosis(13.6%).Six patients(27.3%)required dose reduction or treatment suspension due to severe TRAEs.Conclusion·The dose-reduced,all-oral RMP regimen is safe and effective in treating elderly and frail NDMM patients and is worthy of clinical application.关键词
老年虚弱/新诊断多发性骨髓瘤/来那度胺/美法仑/醋酸泼尼松/剂量减低Key words
elderly frail/newly diagnosed multiple myeloma/lenalidomide/melphalan/prednisone acetate/dose-reduced分类
医药卫生引用本文复制引用
张兴利,田洁,罗菁,刘倩,欧阳皖雁,邱宏春,王焰,糜坚青..剂量减低的来那度胺/美法仑/醋酸泼尼松方案治疗老年虚弱新诊断多发性骨髓瘤的效果分析[J].上海交通大学学报（医学版）,2025,45(7):815-822,8.基金项目
昆山市重点研发计划(社会发展)项目(KS2238). Kunshan Key Research and Development Plan(Social Development)Project(KS2238). （社会发展）
