多发性骨髓瘤诊断和治疗.ppt

* 反应停及反应停联合方案治疗R/RMM Study Regimen No. of Pts ORR CR (No. of Pts) Singhal, 1999 Thalidomide 200-800 mg/day 84 32% 2 Barlogie, 2001 Thalidomide 200-800 mg/day 169 37% 3 Kumar, 2003 Thalidomide 200-800 mg/day 32 31% 0 Richardson, 2004 Thalidomide 200-600 mg/day 30 43% 0 Dimopoulos, 2001 Thalidomide 200-400 mg + Dexamethasone 20 mg 44 55% 0 Palumbo, 2001 Thalidomide 100 mg + Dexamethasone 40 mg 77 66% 2 Dimopoulos, 2004 Thalidomide/Dexamethasone/ Cyclophosphamide 53 60% 3 Garcia-Sanz, 2004 Thalidomide/Dexamethasone/ Cyclophosphamide 49 68% 5 沙利度胺一线治疗MM MDACC MAYO ECOG 方案 TD DT TD D 病例数 130 50 103 107 ≥PR(%) 69 64 69* 51* DVT 24 5# 18 3 * P0.05, # 应用抗凝治疗预防 MP vs. MPT ——在新诊断老年MM中的疗效 方案 N PFS(月) P值 OS(月) P值 MP 191 17.2±1.5 0.0001 30.3±5.8 0.0008 MPT 124 29.5±3.6 56 以雷利度胺为基础的一线化疗方案 研究 病例数 方案 CR/nCR CR＋PR 参考文献 Rajkumar 99 Thal+Dex 4% 63% JCO 2006 Rajkumar 34 Lenal+Dex 38% 91% Blood 2005 Niesvizky 35 Lenal+Dex+Clar 36% 86% ASH 2005 蛋白酶体抑制剂—硼替佐米 NFkB IkB Ubiquitin VCAM-1 VEGF IL-6 硼替佐米单药治疗R/RMM 研究项目 例数 ORR CR/ nCR OS (Ms) TTP (Ms) DOR (Ms) SUMMIT, 2003, 2006 193 28% 10% 17 7 12.7 CREST, 2004 53 38%* 4%* Not Reached 11*? 13.7*? 30%? 11%? 26.7? 7?? 9.5?? Richardson. N Engl J Med. 2003;248:2609; Richardson. Cancer. 2006;106:1316; Jagannath. Br J Haematol. 2004;127:165. 研究 N 方案 CR/nCR CR+PR 干细胞 收集 参考文献 Jagannath 49 Bort +/- Dex 18% 88% Yes ASH 2006 Harousseau 48 Bort + Dex 21% 67% Yes Hematol 2006 Orlowski 29 Bort/PLD 28% 80% Yes ASH 2006 Oakervee 21 PAD 29% 95% Yes BrJH 2005 Jakubowiak 28 Bort/PLD/ Dex 32% 89% Yes ASH 2006 硼替佐米联合化疗显著提升CR率 研究 病例 方案 CR/nCR CR+PR 参考文献 IFM90 100 Autograft x 1 38% 81% NEJM 1996 Child 200 Autograft x 1 44% 86% NEJM 2003 IFM94 200 Autograft x 1 42% 84% NEJM 2003 200 Autograft x 2 50% 88% Oakervee 21 PAD/ Autograft