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NEJM:Daratumumab+来那度胺+地塞米松治疗多发性骨髓瘤疗效显著

2016-10-06 MedSci MedSci原创

在一项涉及复发或难治性多发性骨髓瘤患者的1-2阶段研究中,Daratumumab单独治疗,与来那度胺和地塞米松联合治疗都显示出了较好的功效。原始出处:Meletios A. Dimopoulos,Albert Oriol,Hareth Nahi,et al.Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma,NEJM,

在一项涉及复发或难治性多发性骨髓瘤患者的1-2阶段研究中,Daratumumab单独治疗,与来那度胺和地塞米松联合治疗都显示出了较好的功效。

在这项3期临床试验中,研究人员随机分配569例多发性骨髓瘤患者(之前已经接受过一次或多次治疗)接受来那度胺和地塞米松单独治疗(对照组)或结合daratumumab治疗(daratumumab组)。主要终点是无进展生存期。

经过13.5个月的随访后,共有169例病情恶化或死亡事件发生(daratumumab组53/286例[18.5%]  vs  对照组116/283例[41.0%];风险比,0.37;95%可信区间[CI],0.27〜0.52,分层log-rank检验P<0.001)。在12个月时,对于Kaplan-Meier无进展生存率,daratumumab组为83.2%(95%CI,78.3〜87.2),对照组为60.1%(95%CI,54.0〜65.7)。Daratumumab组的总体反应率要显著高于对照组(92.9% vs 76.4%,P<0.001),Daratumumab组中完全缓解或更好的结果率也比较高(43.1% vs 19.2%,P<0.001)。在daratumumab组中,22.4%的患者具有低于微小残留病变阈值的结果(每105个白细胞中有1个肿瘤细胞),而对照组中有4.6%的患者有该结果(P<0.001),低于微小残留病变阈值的结果与改善预后有关。治疗期间最常见的3或4级不良事件是中性粒细胞减少(daratumumab组发生率为51.9% vs 对照组的发生率为37.0%),血小板减少(12.7% vs 13.5%),和贫血(12.4% vs 19.6%)。Daratumumab组47.7%的患者发生输注相关反应,大多为1级或2级。

将daratumumab加入到来那度胺和地塞米松中可显著延长复发或难治性多发性骨髓瘤患者的无进展生存期。Daratumumab会引起一些输注相关反应,嗜中性白细胞减少的发生率比对照组高。

原始出处:

Meletios A. Dimopoulos,Albert Oriol,Hareth Nahi,et al.Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma,NEJM,2016.10.6

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1889707, encodeId=67181889e07f9, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Thu Dec 01 12:37:00 CST 2016, time=2016-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1911788, encodeId=e40e1911e884a, content=<a href='/topic/show?id=4de7112046c' target=_blank style='color:#2F92EE;'>#mAb#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11204, encryptionId=4de7112046c, topicName=mAb)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25e7304, createdName=snf701207, createdTime=Wed Jun 07 15:37:00 CST 2017, time=2017-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146158, encodeId=12c01461583b, content=学习了,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3j7ibEWPiarwpqibEYqqX9yVibV5uebib0O7hQSOPmqGrb5FfyDbLsLawnz7ShAb5ibtiayWgI5ClMTh5v/0, createdBy=a47c1614293, createdName=童小孩, createdTime=Tue Oct 11 22:46:24 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=145348, encodeId=7af81453483f, content=好文章,受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Oct 11 20:15:33 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=143078, encodeId=400e1430e8ab, content=文章很好,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Mon Oct 10 10:55:34 CST 2016, time=2016-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1349667, encodeId=8f85134966e08, content=<a href='/topic/show?id=7b2356991f' target=_blank style='color:#2F92EE;'>#Daratumumab#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5699, encryptionId=7b2356991f, topicName=Daratumumab)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Fri Oct 07 23:37:00 CST 2016, time=2016-10-07, status=1, ipAttribution=)]
    2016-12-01 jml2009
  2. [GetPortalCommentsPageByObjectIdResponse(id=1889707, encodeId=67181889e07f9, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Thu Dec 01 12:37:00 CST 2016, time=2016-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1911788, encodeId=e40e1911e884a, content=<a href='/topic/show?id=4de7112046c' target=_blank style='color:#2F92EE;'>#mAb#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11204, encryptionId=4de7112046c, topicName=mAb)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25e7304, createdName=snf701207, createdTime=Wed Jun 07 15:37:00 CST 2017, time=2017-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146158, encodeId=12c01461583b, content=学习了,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3j7ibEWPiarwpqibEYqqX9yVibV5uebib0O7hQSOPmqGrb5FfyDbLsLawnz7ShAb5ibtiayWgI5ClMTh5v/0, createdBy=a47c1614293, createdName=童小孩, createdTime=Tue Oct 11 22:46:24 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=145348, encodeId=7af81453483f, content=好文章,受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Oct 11 20:15:33 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=143078, encodeId=400e1430e8ab, content=文章很好,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Mon Oct 10 10:55:34 CST 2016, time=2016-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1349667, encodeId=8f85134966e08, content=<a href='/topic/show?id=7b2356991f' target=_blank style='color:#2F92EE;'>#Daratumumab#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5699, encryptionId=7b2356991f, topicName=Daratumumab)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Fri Oct 07 23:37:00 CST 2016, time=2016-10-07, status=1, ipAttribution=)]
    2017-06-07 snf701207
  3. [GetPortalCommentsPageByObjectIdResponse(id=1889707, encodeId=67181889e07f9, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Thu Dec 01 12:37:00 CST 2016, time=2016-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1911788, encodeId=e40e1911e884a, content=<a href='/topic/show?id=4de7112046c' target=_blank style='color:#2F92EE;'>#mAb#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11204, encryptionId=4de7112046c, topicName=mAb)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25e7304, createdName=snf701207, createdTime=Wed Jun 07 15:37:00 CST 2017, time=2017-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146158, encodeId=12c01461583b, content=学习了,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3j7ibEWPiarwpqibEYqqX9yVibV5uebib0O7hQSOPmqGrb5FfyDbLsLawnz7ShAb5ibtiayWgI5ClMTh5v/0, createdBy=a47c1614293, createdName=童小孩, createdTime=Tue Oct 11 22:46:24 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=145348, encodeId=7af81453483f, content=好文章,受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Oct 11 20:15:33 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=143078, encodeId=400e1430e8ab, content=文章很好,继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Mon Oct 10 10:55:34 CST 2016, time=2016-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1349667, encodeId=8f85134966e08, content=<a href='/topic/show?id=7b2356991f' target=_blank style='color:#2F92EE;'>#Daratumumab#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5699, encryptionId=7b2356991f, topicName=Daratumumab)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Fri Oct 07 23:37:00 CST 2016, time=2016-10-07, status=1, ipAttribution=)]
    2016-10-11 童小孩

    学习了,继续关注

    0

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    2016-10-11 1e10c84am36(暂无匿称)

    好文章,受益

    0

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    2016-10-10 1e10c84am36(暂无匿称)

    文章很好,继续关注

    0

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    2016-10-07 yese

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