Efficacy And Safety Of Carfilzomib Combined With Dexamethasone In The Treatment Of Relapsed Or Refractory Multiple Myeloma

ObjectiveTo explore the efficacy and safety of carfilzomib combined with dexamethasone in the treatment of relapsed or refractory multiple myeloma(RRMM)patients who have been treated with the first generation proteasome inhibitor bortezomib and immunomodulator(lenalidomide or thalidomide).MethodPatients treated in the department of hematology of the affiliated cancer hospital of Zhengzhou University from January 2017 to January 2019 were screened.Among them,32 RRMM patients were suitable and treated with carfilzomib and dexamethasone.The detailed information for efficacy and safety of the treatment were collected and evaluated at the end of each cycle.The main evaluation criteria were overall response rate(ORR),disease control rate(DCR),and the secondary evaluation criteria were overall survival(OS)and progression free survival(PFS).The patients were grouped and compared according to their age,gender,disease classification,whether they had renal insufficiency or not,whether they had diabetes or not.SPSS 22.0 software was used for analysis,Fisher’s exact test was used for counting data comparison,and Log-Rank in Kaplan-Meier survival analysis was used for test,with P<0.05 as the statistical difference.Result1.32 patients in this study can be evaluated.Among those 32 patients evaluated in this study,there were 18 patients above 60 years and 14 under 60 years;10 patients with IgA,22 patients with IgG;8 patients with renal insufficiency and 10 patients with diabetes.As of January 2020,18 patients died and 14 survived.2.By the end of follow-up,18 patients obtained micro response(MR)or above,and ORR is 56.25%and DCR is 68.75%.3.Among these patients above 60 years old,77.78%(14/18)of them obtained MR or above,while 28.57%(4/14)of patients under 60 years old obtained.There was significant difference between the two groups(P=0.011<0.05).The median OS of patients above 60 years old was 21 months,and that of patients under 60 years old was 7 months.The difference of OS between the two groups was statistically significant(P=0.001).PFS was 7 months in patients obove 60 years old and 2 months in patients under 60 years old.The difference of PFS between the two groups was statistically significant(P=0.001).4.There was no significant difference in the curative effect,OS and PFS of the patients with different gender,different types,whether the previous treatment with renal impairment or whether the previous treatment with diabetes.5.Among 32 patients,only one(3.12%)had grade 3 peripheral neuropathy,4(12.50%)of them had herpes zoster,and one(3.12%)had grade 3 pulmonary infection.No serious adverse cardiac events occurred during the treatment.Conclusion1.Carfilzomib combined with dexamethasone brings benefit to RRMM patients and let the patients get long-term clinical remission;2.Carfilzomib combined with dexamethasone can benefit elderly patients;3.For RRMM patients with diabetes mellitus or renal insufficiency as well as different types and genders,carfilzomib combined with dexamethasone is still effective.4.Carfilzomib combined with dexamethasone has an acceptable adverse event profile for RRMM patients.