傅雷华　　洪攀　　傅佳萍　　张志坚　　封蔚莹

[關键词] 多发性骨髓瘤;高危遗传学异常;RVD方案;疗效

[中图分类号] R453.9          [文献标识码] A          [文章编号] 1673-9701（2021）20-0012-05

Clinical observation of RVD regimen in the treatment of elderly patients with high-risk multiple myeloma

FU Leihua   HONG Pan   FU Jiaping   ZHANG Zhijian   FENG Weiying

Department of Hematology， Shaoxing People′s Hospital in Zhejiang Province， Shaoxing   312000， China

[Abstract] Objective To explore the efficacy and safety of RVD regimen （lenalidomide， bortezomib combined with dexamethasone） in the treatment of elderly patients with high-risk multiple myeloma （MM）. Methods Twenty-four elderly patients with high-risk multiple myeloma treated in our hospital from February 2017 to February 2020 were selected as research subjects， and were divided into the full dose group and the reduced dose group according to the chemotherapy dose. They were divided into the HRCA group and the non-HRCA group according to whether carrying high risk cytogenetic abnormality （HRCA）. The overall response rate （ORR） after 4 cycles of chemotherapy were compared， and the safety of RVD regimen were observed. After median follow-up of 17.2 months， the progression-free survival （PFS） and the overall survival （OS） were compared. Results The ORR in the full dose group （81.8%） was higher than that in the reduced dose group（53.8%）， with statistically significant difference（P=0.040）. The ORR in the non-HRCA group was higher than that in the HRCA group， with statistically significant difference（P=0.002）. The PFS in the HRCA group （10.3 months） was significantly lower than that in the non-HRCA group （17.3 months）， with statistically significant difference（P=0.047）. There was no statistically significant difference in the PFS between the full dose group （12.1 months） and the reduced dose group（P=0.791）. There was no statistically significant difference in the median OS between the HRCA group （16.3 months） and the non-HRCA group （not reaching the median OS） （P=0.129）. There was no statistically significant difference in the median OS between the reduced dose group （29.4 months） and the full dose group （not reaching the median OS）（P=0.518）. The most common adverse reaction of RVD regimen was peripheral neuritis， with an incidence rate of 29.2%. The main hematological adverse reaction was neutropenia， with an incidence rate of 12.5%. Conclusion HRCA is an important factor affecting the efficacy and prognosis. RVD regimen has good efficacy and safety in the treatment of elderly patients with high-risk multiple myeloma， and the satisfactory efficacy can be achieved by the reduced dose.