来那度胺联合硼替佐米和地塞米松诱导治疗初诊多发性骨髓瘤患者的疗效和安全性

OBJECTIVE: This study aimed to evaluate the efficacy and safety of lenalidomide combined with bortezomib and dexamethasone（VRD）in the treatment of newly diagnosed multiple myeloma（MM）. METHODS: A total of 150 newly diagnosed patients with MM diagnosed in The First Affiliated Hospital of Soochow University from November 2018 to February 2021 and received VRD as the induction regimen were included to evaluate the safety and efficacy of VRD induction therapy for newly diagnosed MM. RESULTS: The median follow-up was 22 months, two patients（1.3％）died early after treatment, and 148 patients（98.7％）completed induction therapy. 116 patients（77.3％）were mobilized to collect autologous hematopoietic stem cells, 101 cases（87.1％）were qualified in the collection, of which 48 cases（41.4％）were excellent in the collection. The 3-year progression-free survival（PFS）rate was 59％, and the 3-year overall survival（OS）rate was 83％. After induction, complete remission（CR）/stringent CR rate was 54.4％, ≥very good partial remission rate was 77.3％, overall response rate was 86.0％, and minimal residual disease negative rate was 46.0％. There was no statistically significant difference in the efficacy of cytogenetic high-risk patients compared with standard risk patients（P＝0.456）. The median PFS time of cytogenetic high-risk patients was shorter than that of standard risk patients（not reached vs 33 months, P＝0.014）. There was no statistically significant difference in the median OS time（not reached vs not reached, P＝0.072）. The highest incidence of hematological adverse events was thrombocytopenia（72％）, followed by neutropenia（42％）and anemia（20％）. The highest incidence of non-hematological adverse events was peripheral neuritis（56.7％）. The main digestive tract symptoms include constipation（30.0％）and diarrhea（17.3％）. Upper respiratory tract infection（23.3％）and lung infection（7.3％）are the main infections. The incidence of adverse thrombocytopenia（90.0％ vs 63.7％, P＝0.001）, neutropenia（54.2％ vs 36.3％, P＝0.038）, anemia（33.3％ vs 13.7％, P＝0.005）, diarrhea（27.1％ vs 12.7％, P＝0.030）, limb edema（20.8％ vs 3.9％, P＝0.030）, fever（20.8％ vs 4.9％, P＝0.006）, thrombosis（8.3％ vs 0, P＝0.016）, and renal function deterioration（20.8％ vs 3.9％, P＝0.030）in patients with renal insufficiency was higher than that in patients with normal renal function. CONCLUSION: The VRD regimen has a significant effect on newly diagnosed MM, does not affect the hematopoietic stem cell collection, and has controllable adverse events; however, the incidence of adverse events was higher in patients with renal insufficiency.