Efficacy Of Three Therapy Regimen In The Treatment Of Newly-diagnosed Multiple Myeloma

Objective: To compare the effectiveness, side-effects and median survival of three different regimens(modified M2, VADT and VDT) by retrospective study of patients with multiple myeloma(MM). All the influence factors, such as clininal stage,karyotypes of MM, and renal function were taken into the consideration to provide ideas for the choice of clinical therapy.Methods: Retrospective analysis was performed on the patients with multiple myeloma from January 2002 to February 2015 who visited our clinic, we chosed the patients who had have received 4 cycles of one regimen: modified M2(melphalan+prednisone+vincristine+cyclophosphamide+pirarubicin), VADT(vincristine+pirarubicin+dexamethasone+thalidomide) or VDT(bortezomib+dexamethasone+thalidomide)induction therapy in the First Affiliated Hospital of Dalian Medical University. We collected the following information of patients general information, biomolecular indicators, adverse events and date of death. All the data were analyzed by chi-square test, Fisher test and Log-rank test.Results:1. In the 351 patients with newly diagnosed multiple myeloma, we analyzed 117patients(male/female, 68/49; the ratio of gender was 1.39:1; median age was 62)who had have received 4 cycles therapy, 21 patients with modified M2 regimen(median age was 63), 53 patients with VADT regimen(median age was 60), 43 patients with VDT regimen(median age was 65).2. Effectiveness of the modified M2 and VADT regimens: the overall response rates(ORRs) after 2 cycles chemotherapy were respectively 38.1% and 75.4%, the ORRs after 4 cycles were 61.9% and 81.1%(P=0.082). The complete remission rates(CRRs) after 2 cycles therapy were 0% and 5.7%, and the CRRs after 4 cycles were 4.8% and 17.0%(P=0.313).Both the ORR and the CRR of VADT was morethan that of modified M2, but the difference had no statistical significance.3. Effectiveness of the modified M2 and VDT regimen: the ORRs after 2 cycles were respectively 38.1% and 90.7%, the ORRs after 4 cycles were 61.9% and 95.3%(P=0.002). The CRRs after 2 cycles therapy were 0% and 20.9%, the CRRs after 4cycles were 4.8% and 51.2%(P=0.001).4. Effectiveness of the VADT and VDT regimen: the ORRs after 2 cycles were respectively 75.4% and 90.7%, the ORRs after 4 cycles were 81.1% and 95.3%(P=0.036). The CRRs after 2 cycles therapy were 5.7% and 20.9%, the ORRs after4 cycles were 17% and 51.2%(P=0.000).5. Among the three regimens, the ORRs and the the CRRs of the third stage were lower than that in the first and second stage of both ISS and DS clininal staging system.But the differences were not statistically significant.6. In the modified M2 regimen, the ORR of patients who were grouped in light chain type was higher than that in non-light chain type group(P=0.015). In the VADT and VDT regimens, the CRR of patients with light chain type was higher than that with non-light chain type(P=0.018; P=0.030). However, disease types had no impact on CRR or ORR.7. Among the three regimens, the patients with renal dysfunction have lower the ORR and the the CRR.But the differences have no statistical significan.8. In the modified M2 regimen,the most common grade 1-2 adverse event was the digestive tract reaction(7 cases 33.3%).The most common grade 3-4 adverse event was neutropenia in 2 cases(9.5%), 1 case deep vein thrombosis(4.8%). In the VAD regimen, the most common grade 1-2 adverse event was the digestive tract reaction in 14 cases(26.4%), the most common grade 3/4 adverse event was neutropenia in5 cases(9.4%), 2 cases of patients with cardiac toxicity(3.8%). In the VDT regimen, the most common grade 1 or 2 adverse event was peripheral neuritis in 21cases(48.8%), no patients had deep vein thrombosis and heart toxicity.9. In the modified M2 regimen, median survival time was 22.3 months. In the VAD regimen, median survival time was 48.7 months. In the VDT regimen, the median survival time could not be accurately assessed. 3 years’ survival rate of VDT regimen was 66.5%, which was more than M2 group(30.8%) and VADT group(55.2%)(p=0.0264<0.05). Compared three groups with each other, three years’ survival rate of VDT group was highest, then VADT group, and modified M2 wasleast, although the difference is not statistically significant(P= 0.2777>0.05,P=0.2777>0.05). However, overall survival time of the VDT group was longer than that of modified M2 regimen with statistical significance(P =0.0221<0.05).Conclusions:1. The highest ORR and CRR were seen VDT regimen. The ORR and CRR of VADT regimen were higher than that of modified M2 regimen. But there was no statistically significant difference.2. The karyotypes of patients with MM had influence on overall response rate and complete remission rate. But ISS or DS clinical staging and renal function showed no impact on overall response rate and complete remission rate obviously.3. VDT regimen had low incidence of adverse events, most of which were mild in 1-2level, and no heart toxicity or deep vein thrombosis were observed.4. 3 years’ survival rate of VDT regimen was, which was more than modified M2 and VADT group. The difference is statistically significant.