| Objective:To further observe the clinical efficacy and adverse effects of bortezomib,pomalidomide,and dexamethasone(VPd)regimen in the treatment of relapsed/refractory multiple myeloma(RRMM),this study used a retrospective study to evaluate the efficacy and safety of VPd regimen for relapsed/refractory multiple myeloma.Methods:Data were collected on patients with relapsed/refractory multiple myeloma who attended the Affiliated Hospital of Qingdao University and Yantai Yuhuangding Hospital from December 2020 to August 2022 and received at least 1 cycle of VPd regimen induction therapy.Blood,urine and bone marrow samples were collected before they were treated with the VPD regimen and after they completed each cycle of treatment to assess efficacy and safety.Overall Survival(OS),Overall response rate(ORR),Progression-free survival(PFS),changes in renal function,and the occurrence of adverse effects and tolerance of the treatment were observed.Groups were divided according to different baseline levels,for example the gender,age at first recurrence,first/multiple recurrences,presence or absence of extramedullary involvement,myeloma cell count,endogenous creatinine clearance rate,RISS stage,cytogenetics,and resistance to lenalidomide.SPSS26.0 software was used to statistically analyze the treatment effect and survival time within each group,P<0.05 was considered a statistically significant difference.Results:1.A total of 58 patients with RRMM were included in the study.All patients completed 4 cycles of treatment,with an ORR of 86.21%.40(68.97%)patients completed 8 cycles of treatment,with an ORR of 82.57%.21(36.20%)patients completed 12 cycles of treatment,with an ORR of 100.00%.The median PFS time was 10.24(2.31~20.83)months and one-year PFS rate is 56.1%.The median OS time was 15.82(4.58~20.87)months and one patient died due to disease progression.By the end of this study,21(36.20%)patients were still on treatment.37 patients discontinued treatment for reasons such as disease progression,financial and other reasons.2.Among the 58 patients,grouped according to age at first relapse(≥60 years vs.<60 years),gender(male vs.female),first vs.multiple relapses,presence or absence of extramedullary involvement,myeloma cell count(≥40% vs.<40%),CCr(≥60ml/min vs.<60 ml/min),RISS stage(stage I+II vs.stage III)and cytogenetics(standard risk vs.high risk),the differences in ORR,OS and PFS within each group were not statistically significant(P>0.05).3.All patients were previously treated with lenalidomide.According to the sensitivity to lenalidomide,they were divided into drug resistant group(n=36)and sensitive group(n=22).After treatment,the ORR was 83.31% and 90.97%respectively,and the PFS rate was 33.34% and 54.58% respectively,the difference was statistically significant(P<0.05).Cytogenetic characteristics could be known in45 patients,with a total of 35 high-risk patients,of which del(17p)accounted for16(45.71%)cases and t(4;14)for 10(28.57%)cases,with ORRs of 87.56% and80.08% and 1-year PFS rates of 43.82% and 30.09%,respectively,the difference was statistically significant(P<0.05).4.A total of 25 patients with renal insufficiency before treatment had significantly lower creatinine(Cr)and significantly higher endogenous creatinine clearance(CCr)at baseline level after treatment compared with the baseline level before treatment,with statistically significant differences(P<0.05).The difference was statistically significant(P<0.05)when patients had lower Cr levels and higher CCr levels for 8courses of treatment compared with 4 courses of treatment,while the difference in Cr and CCr was not statistically significant(P>0.05)when patients had 12 courses of treatment compared with 4 courses of treatment.5.The overall safety of the 58 RRMM patients treated with the VPd regimen was good.Of the Grade 1-2 Adverse Events(AEs)that occurred in the patients,the most common of the hematologic AEs was thrombocytopenia and the most common of the non-hematologic AEs was infection.Only three patients with grade 3 to 4 AEs occurred,all of whom were thrombocytopenic.All of these adverse reactions were resolved with symptomatic supportive treatment,and there were no drugs dose reductions or discontinuations or deaths due to adverse reactions during the course of treatment.Conclusion:1.The ORR of VPd regimen for RRMM can reach 86.21% and the adverse effects can be controlled,indicating that the VPd regimen has good efficacy and safety in the treatment of RRMM.2.For RRMM patients with renal function impairment,VPd regimen can improve renal function to a certain extent.3.Patients with RRMM previously treated with lenalidomide had a better prognosis in the sensitive group than in the resistant group,but a higher ORR was achieved in both groups;therefore,the VPD regimen remains a treatment option for patients with lenalidomide-resistant RRMM.4.In RRMM patients with high-risk cytogenetic features,the VPd regimen had better efficacy in RRMM patients with del(17p)compared to t(4;14)mutations. |
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