불응성/재발성 다발골수종의 볼테조밉 구제 치료의 실제: 단일 기관의 경험
Bortezomib-Based Salvage Chemotherapy in Refractory/Relapsed Multiple Myeloma Patients: A Single Center Experience in Real Clinical Practice
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목적: 본 연구의 목적은 실제 진료실에서 볼 수 있는 환자군의 현실을 반영하여 볼테조밉의 효과 및 독성을 보기 위함이다. 방법: 다발골수종이 진행된 환자들과 전신수행 상태가 감소된 환자들을 대부분 포함한 37명의 환자를 대상으로 분석을 하였다. 결과: 이전에 많은 항암 요법에 실패한 환자에서 볼테조밉의 치료는 전체 반응률 64.9%로 실제 임상에서도 매우 효과적이었다. 독성으로 인하여 치료를 중단한 예는 59.5%였으나 4주기 이상 길게 치료하는 경우 추가적인 반응을 얻는환자가 16.2%에서 있었다. 결론: 비록 본 연구에서는 독성으로 인하여 치료를 중단한 예가 많았으나 볼테조밉의 독성을 잘 조절하여 4주기 이상 길게 치료하는 경우 반응의 정도를 높이면서 다발골수종의 진행을 지연시킬 수 있을 것으로 생각된다.
Abstract
Background/Aims: Bortezomib-based chemotherapy has proven to be an effective salvage regimen for refractory/relapsed multiple myeloma patients in many clinical trials. However, few reports have shown the outcomes and adverse events of bortezomib-based salvage chemotherapy in clinical practice. Methods: From April 2006 to September 2011, 37 patients were retrospectively analyzed. A total of 19 patients received bortezomib therapy and 18 patients received bortezomib plus dexamethasone therapy. Results: The median follow-up duration was 18.13 months (range, 0.97-87.20 months). The median number of cycles administered was four (range, 1-13). The overall response rate by International Myeloma Working Group (IMWG) 2006 criteria was 64.9%, including six complete responses (16.2%). The median number of cycles to best response was three (95% confidence interval [CI], 1.36-4.64). Six patients achieved their best responses after four cycles of bortezomib therapy. The median time to progression and overall survival were 5.10 (95% CI 4.03-6.17), and 23.10 (95% CI, 9.24-36.96) months, respectively. The incidence of grade 3/4 neutropenia and thrombocytopenia was 29.7% and 64.9%, respectively. A total of 27.0% patients experienced grade 3 peripheral neuropathy. Herpes zoster developed in 11 patients (29.7%). Treatment was stopped in 22 patients (59.5%) due to adverse events after bortezomib-based therapy, and treatment-related mortality occurred in 4 of 25 deaths in total. Conclusions: Bortezomib-based therapy is a very effective salvage regimen in real clinical practice, although patients relapse after multiple chemotherapies. Despite intolerable in some patients, management of toxicities and extended cycles of therapy could benefit more patients, resulting in higher response rates.
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