MM 1 0 1971 2006 1996 2006 1971

MM总生存期的趋势 1. 0 总生存期 1971– 2006 诊断周期 1996– 2006 1971– 1996 0. 8 2001– 2006 生存率 0. 6 45 个月 30 个月 (P<0. 001) OS, overall survival. 0. 4 0. 2 0 0 2 中位 OS 20 40 60 80 100 距离诊断时间(月) Kumar SK, et al. Blood. 2008; 111: 2516 -2520. 120 140 1971– 1976 1989– 1994 1977– 1982 1995– 2000 1983– 1988 2001– 2006 M

CR与诱导后和移植后OS延长相关 只接受化疗 化疗和移植 291例（年龄<70岁）MM患者只接受化疗，375例化疗后接受移植（右），比较两种情 况生存率与缓解程度的关系(CR vs PR or NR P<0. 01) 1. Lahuerta et al. J Clin Oncol. 2008; 26(3): 5775 -5782. 2. Alexanian et al. Bone Marrow Transplant. 2001; 27: 1037 -1043. 3. Wang, et al. Bone Marrow Transplant. 2010; 45(3): 498 -504. 4

CR对老年MM患者的重要性 > 65岁 > 75岁 Gay F et al. Blood. 2011; 117(11): 3025 -3031)

基于硼替佐米的移植前诱导治疗 Regimen N CR+VGPR Post. Induction (%) Cavo et al, 2010 VTD vs TD 236 62* 82* 68% at 3 yr 238 28 64 56% at 3 yr Moreau et al, 2011 IFM 2007/02 VD vs v. TD 99 36 58 100 49‡ 74§ Trial CR+VGPR Post. ASCT (%) PFS Median 30 months Median 26 mo P Value. 0057 . 22 *P <. 001; †P =. 001; ‡P =. 05; §P =. 02 GMMG= German Multiple Myeloma Group; SCT = stem cell transplant; CR = complete response; VGPR = very good partial response; PAD = bortezomib (V)/AD; T = thalidomide; VAD = vincristine, doxorubicin (A), dexamethasone (D); v. TD = reduced-dose bortezomib. Cavo M, et al. Lancet. 2010; 376: 2075 -2085. Harousseau JL, et al. J Clin Oncol. 2010; 28: 4621 -4629. Sonneveld P, et al. ASH Annual Meeting Abstracts. 2010; 116(21): 40. http: //web. educationalconcepts. net/Newsletter/MMY 015 AE 1. pdf. Accessed July 17, 2012. Moreau P, et al. Blood. 2011; 118: 5752 -5758.

老年MM患者：MPT vs MP Fayers PM et al. Blood. 2011; 118(5): 1239 -1247

老年MM患者：MPR vs MP Palumbo et al. N Engl J Med 2012; 366: 1759 -69.

硼替佐米治疗不适合移植MM患者 Study Regimen VISTA San Miguel et al. VMP Mateos et al. MP Phase III UPFRONT Niesvizky et al. Phase III VMP/Vel VTD/Vel VD/Vel N ORR CR/n. CR Outcomes 344 338 71% 35% 33% 4% 5 yr OS: 46% 5 yr OS: 34. 4% 300 73% 79% 71% 36% 34% ORR: overall response rate; CR: complete response; n. CR: near complete response; OS: overall survival; TTP: time to progression; PFS: progression free survival; VMP: Bortezomib-melphalandexamethasone; MP: Melphalan-Prednisone; VTP: Bortezomib-thalidomide-dexamethasone; VTD: bortezomib-thalidomide-dexamethasone; VD: bortezomib-dexamethasone; VMPT-VT: bortezomibmelphalan-prednisone-thalidomide followed by bortezomib-thalidomide maintenance