| Objective Bortezomib,lenalidomide,and dexamethasone(VRD)has become the first-line treatment for newly diagnosed multiple myeloma(NDMM).This study investigated the efficacy,safety,and impact on stem cells of VRD in the treatment of NDMM in the real world.Methods The clinical data of 40 patients with NDMM treated with VRD regimen in the Department of Hematology of the General Hospital of North Theater from June 2019 to December 2020 were collected.Specific medication for VRD regimen:bortezomib 1.3mg/m~2 subcutaneously on d1,4,8,11,lenalidomide 25 mg orally on d1-14,and dexamethasone 20 mg intravenously/orally on d1-2,4-5,8-9,11-12,21 days as a cycle.The effects of age,gender,DS stage,ISS stage,immunophenotyping,serum albumin,hemoglobin,lactate dehydrogenase,creatinine clearance rate,and bone marrow plasma cell ratio on the efficacy of VRD regimen were analyzed,and the influence factors of VRD regimen on autologous hematopoietic stem cell collection were analyzed.Results1.The best response was achieved in 12 patients(30.0%)with CR,16 patients(40%)with VGPR,9 patients(22.5%)with PR,1 patient(2.5%)with MR,1 patient(2.5%)with SD,and 1 patient(2.5%)with PD,ORR of 92.5%.In gender,age(>65 years and≤65 years),DS stage,ISS stage,ISS-R stage,serum creatinine,lactate dehydrogenase,corrected serum calcium,β2 microglobulin,and plasma cell ratio groups,there were no statistically significant differences in the comparative efficacy,p>0.05.2.Referring to the DS staging criteria,patients were divided into two groups according to whether HGB was≥85 g/L or<85 g/L at initial diagnosis,and the proportions of≥VGPR between the two groups were 88.0%and 40.0%,p=0.001.Referring to ISS staging criteria,patients were classified as≥35 g/L and<35 g/L according to whether the serum albumin score was≥35 g/L at initial diagnosis,and the proportions of≥VGPR between the two groups were 88.2%and 56.5%,respectively,p=0.03.Referring to the DS stage group A/B criteria,according to whether Ccr was≥40 m L/min at initial diagnosis,they were divided into≥40 m L/min and<40 m L/min,and the proportion of≥VGPR was 79.3%and 45.5%between the two groups,p=0.037.3.There were 19 cases of IgG type,10 cases of Ig A type,4 cases of Ig D type,and 7cases ofκtype in each immunophenotype,and the proportions of efficacy≥VGPR were 73.7%,60.0%,100%,and 57.1%,respectively,p>0.05.4.Twenty-four patients underwent in fluorescence immunofluorescencesitu hybridization(FISH)for 1q21,del(17p),t(4;14),t(14;16),t(14;20),the results were negative in 6 patients and positive in 18 patients,including 1q21+in 15 patients,t(4;14)in 3 patients,and del(17p)in 6 patients.One result was abnormal in 12 cases,including 9 cases of 1q21+,2 cases of del(17p),and 1 case of t(4;14).There were 6cases with abnormal results in 2 items,4 cases with 1q21+and del(17p),and 2 cases with 1q21+and t(4;14).There were 9 cases of positive and 6 cases of negative 1q21alone,of which the proportion of efficacy≥VGPR was 55.6%and 66.7%,respectively,p=0.202.The proportion of patients with≥VGPR in del(17p)positive group was 83.3%and 66.7%,respectively,p=0.437.And the proportion of efficacy≥VGPR in the t(4;14)was 100%and 66.6%,respectively,p=0.235.5.Autologous peripheral blood stem cells were collected in 14 patients.3～4 courses of VRD were completed before collection,and the number of mononuclear cells was 5.25(2.08-14.64)×10~8/kg.The number of CD34+cells was 2.47(0.33-15.61)×10~6/kg.8patients achieved CR,4 patients achieved VGPR,and 2 patients achieved PR in response when stem cells were collected.There were no statistically significant differences in the number of CD34+cells when efficacy,cytogenetics,white blood cell count,and time from the end of lenalidomide medication to stem cell collection were achieved before mobilization,p<0.05.6.Three patients had extramedullary infiltration at onset,involving the left frontal lobe,left chest wall,and paravertebral region,the efficacy achieved CR,PR,and PR,respectively,and continued to respond until the end of follow-up.One patient developed meningocentric infiltration during VRD therapy 4 months after onset.7.Among the 40 patients,25%had peripheral neuropathy,mainly manifested as numbness in both hands and toes,which was alleviated by application of trophic nerve drugs,discontinuation,or change of bortezomib once a week.Leukopenia accounted for10%,thrombocytopenia accounted for 10%,herpes zoster accounted for 2.5%,pneumonia accounted for 15%,gastrointestinal reactions mainly including nausea,vomiting,constipation,diarrhea accounted for 7.5%,rash accounted for 5%,thrombosis accounted for 2.5%,hiccup 10%,the above can be improved after symptomatic treatment.Conclusion 1.In real-world studies,the ORR of VRD regimen in the treatment of NDMM was 92.5%,the proportion of≥VGPR was 70%,and the effect of extramedullary infiltration was greater than that of PR.2.DS staging,ISS staging,ISS-R staging,β2 microglobulin,HCG,serum creatinine,LDH,serum albumin,corrected serum calcium,plasma cell ratio and creatinine clearance had effects on the remission depth of NDMM treated with VRD,especially HGB,serum albumin and creatinine clearance rate.3.Immunophenotyping and cytogenetics had no effect on short-term response rate.4.Peripheral blood stem cell collection is usually preceded by 3-4 courses of VRD therapy,and the application of G-CSF mobilization can basically meet the criteria.5.The incidence of adverse reactions was about 42.5%,of which the incidence of PN was 20%. |
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