Efficacy Of Pomalidomide-containing Regimen For Relapsed Refractory Multiple Myeloma And Analysis Of Factors Influencing The Treatment

Objective Efficacy of pomalidomide-containing regimen for relapsed refractory multiple myeloma and analysis of factors influencing the treatment.Methods Patients with multiple myeloma seen in the Department of Hematology at our hospital from January 2020 to March2023 were retrospectively included,all of whom had received 1-3 previous treatments that progressed during treatment or were ineffective for the last treatment,with the observation group being the pomalidomide-containing treatment group and the control group being the pomalidomide-free treatment group.General information at the time of relapse was collected:age,gender,biochemistry,blood routine,bone aspiration,blood smear,and FISH results in both groups.The time to disease progression,time to death and adverse effects during the treatment of the included patients were recorded by telephone,outpatient or inpatient follow-up,and progression-free survival and overall survival were analyzed.Result(1)Seventeen cases in the observation group achieved PR and above with an ORR of 68%,while6 cases in the control group achieved PR and above with an ORR of 35.29%,with statistically significant differences(P < 0.05).(2)The median PFS was 7.3 months in the observation group and 3.3 months in the control group,with a statistically significant difference between the two groups(P < 0.01).OS was not achieved in both groups.(3)In the comparison of the survival curves between the observation group and the control group,PFS with different influencing factors was well improved in the observation group.In the group with different treatment regimens for renal insufficiency,the median PFS was 7.0 months in the observation group and 3.0 months in the control group,with a significant difference between the two groups(P=0.001).In the different treatment regimens for extramedullary lesions,the median PFS was 4.5 months in the observation group and 2.4 months in the control group,with a statistically significant difference between the two treatment groups(P=0.038).(4)The median PFS was 4.6 months in the observation group and 3.3 months in the control group in the two treatment regimens for the high-risk stratification,a significant difference(P=0.002).The median PFS was 8.0 months in the standard risk stratification in the observation group and4.6 months in the high-risk stratification,with a difference between the two groups(P=0.026).(5)Median PFS was significantly prolonged in the observation group without extramedullary disease(P< 0.01);median PFS was also prolonged in the control group without extramedullary disease(P=0.022).The median PFS in the observation group with elevated lactate dehydrogenase(LDH)was 4.5 months,which was significantly shorter(P < 0.01);the median PFS in the control group with elevated LDH was also significantly shorter(P < 0.01);there was no significant difference in the age grouping of the two groups(P > 0.1).(6)Univariate prognostic analysis showed that protocol grouping,risk stratification,LDH >240 U/L,and the presence of extramedullary plasmacytoma were factors affecting PFS.Pomalidomide use was a protective factor for PFS,and extramedullary plasmacytoma and elevated LDH >240 U/L were all independent risk factors for PFS.(7)Risk stratification as a single factor influenced the prognosis of PFS and was not observed in the multifactorial analysis.patients with Ig D type had rapid disease progression,poor prognosis,and extremely poor response to treatment,but only one patient in each group could not be statistically analyzed.(8)Grade 3-4 adverse reactions were predominantly hematological in both groups(P > 0.1),with more pronounced hematological adverse reactions in the observation group;there were two cases of grade 3-4thrombosis in the observation group,while no grade 3-4 thrombotic adverse reactions were observed in the control group,and none of the deaths caused by thrombotic adverse reactions occurred.(9)There were significantly fewer patients with moderate and severe NRS scores after treatment in the observation group;there were also significantly fewer patients with moderate and severe scores after treatment in the control group(P < 0.05);however,the difference between the different treatment groups was not significant after treatment(P =0.722).Conclusion 1.The pomalidomide-containing treatment group significantly improved progression-free survival(7.3 vs.3.3 months,P < 0.01)and overall remission rate(68% vs.35.29%,P < 0.05)in patients with relapsed refractory multiple myeloma compared with the control group,and median survival was not reached.2.PFS with different influencing factors(renal insufficiency,extramedullary lesions,high-risk stratification)was well improved in the pomalidomide-containing treatment group.3.Protocol grouping,risk stratification,LDH >240 U/L,and the presence of extramedullary plasmacytoma were factors affecting PFS.Pomalidomide use was a protective factor for PFS,extramedullary plasmacytoma,and elevated LDH >240 U/L were independent risk factors for PFS.4.Adverse effects were predominantly hematological,with more pronounced hematological and thrombotic adverse effects in the pomalidomide-containing treatment group.5.There were significantly fewer patients with moderate and severe NRS scores in the observation and control groups after treatment,but the difference was not significant between the different treatment groups after treatment,and the addition of pomalidomide did not significantly improve bone pain symptoms.