A clinical practice study of TADA-based individualised treatment regimens for patients with early relapse of multiple myeloma
Objective To explore the efficacy and safety of thalidomide,arsenic trioxide,dexamethasone and ascorbic acid(TADA)regimen in the treatment of early relapsed multiple myeloma(MM)patients(tumor progression within 12 months after initial treatment).Methods This study retrospectively analyzed 62 patients on TADA chemotherapy regimen and 57 patients on bortezomib,lenalidomide,dexamethasone(velcade,revlimid,dexamethasone,VRD)chemotherapy regimen for multiple myeloma(MM)in early stage relapse,who visited the Department of Hematology of Yanbian University Hospital between 2008 and 2020.We collected the general data profile,follow-up data during 3 courses of treatment,and laboratory data of all patients before and after chemotherapy.The efficacy of the patients was assessed by overall response rate(ORR)and complete response rate(CRR),and the occurrence of adverse reactions was collected for statistical analysis.Kaplan-Meier curves were plotted for the TADA and VRD groups under different renal function conditions,cytogenetically different risk stratification,and different ISS scenarios;the prognosis of patients on the TADA chemotherapy regimen was analyzed.Results There were no statistical differences in age,gender,immunochemical subtypes,ISS staging and high-risk FISH indicators between the two groups(P＞0.05).After chemotherapy,the haemoglobin and serum albumin of patients in the TADA group were significantly lower than those in the VRD group,whereas the percentage of blood calcium,blood β2 microglobulin,creatinine and bone marrow plasma cells were significantly higher than those in the VRD group(P＜0.05).In addition,the incidence of peripheral neuropathy was significantly lower than that in the VRD group(P＜0.05),and there was no statistically significant difference in other adverse reactions(P＞0.05).Compared with those in the VRD group,the overall survival(OS)(X2=8.201,P=0.004)and progression free survival(PFS)(x2=7.568,P=0.006)survival curves were statistically significant in the TADA group.In the TADA group OS(X2=3.924,P=0.048)in patients with normal and impaired renal functionat the time of enrolment and PFS(x2=9.008,P=0.003),OS(x2=9.330,P=0.002)and PFS(x2=16.090,P＜0.001)in ISS stage Ⅰ/Ⅱ and ISS stage Ⅲ at enrolment,OS(X2=10.149,P＜0.001)in high-risk FISH and non-high-risk patients at enrolment and PFS(X2=11.286,P＜0.001)survival curve results showed statistically significant differences.Conclusion The TADA regimen has better efficacy and safety in patients with early recurrence of MM.Renal function,ISS staging and FISH stratification are important factors affecting patients'prognosis.
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