课件：MM的整体治疗.ppt

* * * * * * * * * * * * * * * Panel A shows the time to disease progression on the basis of assessment by the investigators; the median time to progression was 24.0 months in the bortezomib group and 16.6 months in the control group (hazard ratio in the bortezomib group, 0.48). According to algorithmic analysis, the median time to progression was 20.7 months in the bortezomib group and 15.0 months in the control group (hazard ratio in the bortezomib group, 0.54; P0.001). Panel B shows overall survival after a median follow-up of 16.3 months. Median survival was not reached in either group. During that time, 45 patients (13%) in the bortezomib group and 76 patients (22%) in the control group died (hazard ratio in the bortezomib group, 0.61). * OS on an ITT basis after median follow-up of 36.7 mo (or 3 years). Median number of treatment cycles administered: 9 in VMP (50 weeks) versus 8 in MP (48 weeks). VMP arm had 35% reduction in death versus MP. Three y OS: 68 % versus 54% OS in patients who had received subsequent therapy Survival from start of second-line therapy for all patients receiving second-line therapy Survival from start of second-line therapy for all patients receiving novel agents Conclusion: by giving VMP upfront there were no more agressive relapses GIMEMA（VMPT-VT vs VMP）：意大利MM工作组 PETHEMA/GEM（VMP vs VTP诱导，VT vs VP维持 ）：西班牙骨髓瘤工作组，This study was undertaken in 63 Spanish centres between March, 2006, and October, 2008. * * 治疗流程 新药 诱导治疗 维持治疗 初诊MM 65 岁 N=255 随 机 MPT-T (n=129)，4周/6疗程 马法兰 4mg/m2 d1-7 泼尼松 40mg/m2 d1-7 沙利度胺 100mg/d 持续直至疾病进展 MP (n=126)，4周/6疗程 马法兰 4mg/m2 d1-7 泼尼松 40mg/m2 d1-7 Palumbo A et al. Lancet 2006; 367:825-831. 对于高龄的MM病人：口服 MPT是有效的一线治疗方案。 ≥PR ≥nCR 2年EFS 3年OS ≥3级AE MPT-T 76.0% 27.9% 54% 80% 48% MP 47.6% 7.2% 27% 64% 25% p值 0.0006 0.19 0.0002 Lancet 2006; 367: 825–31 Blood. 2011;118(22):5759-5766 NDMM ≥65ys Randamized Vel 1.3mg/m2 d1,4, 8, 11, 22, 25, 29, 32 Mel 9mg/m2 d1-4 Pred 60mg/m2 d1-4 Thal 50mg/d Induction, Q6w, cycles1-4 mainte