Abstract：
BACKGROUND: This retrospective longitudinal study compared the effectiveness of dexamethasone+lenalidomide (Rd)-based triplet regimens containing proteasome inhibitors (PIs) ixazomib (IRd), carfilzomib (KRd), and bortezomib (VRd) or monoclonal antibodies (MABs) elotuzumab (ERd) and daratumumab (DRd) in patients with relapsed/refractory multiple myeloma (RRMM)-including those with high cytogenetic risk-primarily treated at community oncology clinics in the United States.
METHODS: Electronic health records of adult RRMM patients in a deidentified real-world database (01/01/2014-09/30/2020) who initiated IRd, KRd, VRd, ERd, or DRd in the second or later line of therapy (LOT) were analyzed. The index date was the date of initiation of each LOT and baseline was the 6-month pre-index period. Duration of therapy (DOT), time to next therapy (TTNT), progression-free survival (PFS), and overall survival (OS) were compared across regimens with multivariable Cox proportional hazards models.
RESULTS: Of the 1,185 patients contributing 1,332 LOTs, 985 had standard cytogenetic risk (median age, 71 years) and 180 had high risk (median age, 69 years). Compared with other regimens, DRd was associated with longer DOT overall (adjusted hazard ratio [95 % confidence interval]: 1.84 [1.42, 2.38] vs. KRd, 1.65 [1.20, 2.28] vs. ERd, 1.58 [1.23, 2.04] vs. IRd, and 1.54 [1.18, 2.00] vs. VRd), and longer TTNT and PFS. KRd was associated with shorter OS compared with DRd (1.45 [1.01, 2.08]) and VRd (1.32 [1.01, 1.73]). High-risk patients had similar outcomes with all triplet regimens.
CONCLUSIONS: Although DRd improved clinical outcomes overall, Rd-based triplet regimens containing a PI or MAB are similarly effective in high-risk RRMM.
METHODS: Electronic health records of adult RRMM patients in a deidentified real-world database (01/01/2014-09/30/2020) who initiated IRd, KRd, VRd, ERd, or DRd in the second or later line of therapy (LOT) were analyzed. The index date was the date of initiation of each LOT and baseline was the 6-month pre-index period. Duration of therapy (DOT), time to next therapy (TTNT), progression-free survival (PFS), and overall survival (OS) were compared across regimens with multivariable Cox proportional hazards models.
RESULTS: Of the 1,185 patients contributing 1,332 LOTs, 985 had standard cytogenetic risk (median age, 71 years) and 180 had high risk (median age, 69 years). Compared with other regimens, DRd was associated with longer DOT overall (adjusted hazard ratio [95 % confidence interval]: 1.84 [1.42, 2.38] vs. KRd, 1.65 [1.20, 2.28] vs. ERd, 1.58 [1.23, 2.04] vs. IRd, and 1.54 [1.18, 2.00] vs. VRd), and longer TTNT and PFS. KRd was associated with shorter OS compared with DRd (1.45 [1.01, 2.08]) and VRd (1.32 [1.01, 1.73]). High-risk patients had similar outcomes with all triplet regimens.
CONCLUSIONS: Although DRd improved clinical outcomes overall, Rd-based triplet regimens containing a PI or MAB are similarly effective in high-risk RRMM.
摘要：
背景：这项回顾性纵向研究比较了含蛋白酶体抑制剂（PIs）的地塞米松+来那度胺（Rd）的三联方案的有效性，卡菲佐米（KRd），和硼替佐米（VRd）或单克隆抗体（MABs）elotuzumab（ERd）和daratumumab（DRd）用于复发/难治性多发性骨髓瘤（RRMM）患者-包括那些主要在美国社区肿瘤诊所接受治疗的高细胞遗传风险患者。
方法：启动IRd的成人RRMM患者的电子健康记录（2014年1月1日-2020年9月30日），KRd,VRd,ERd,或DRd在第二或以后的治疗线（LOT）进行了分析。索引日期是每个LOT的开始日期，基线是6个月的索引前阶段。治疗持续时间（DOT），下一次治疗时间（TTNT），无进展生存期（PFS），采用多变量Cox比例风险模型,比较了不同治疗方案和总生存期(OS).
结果：在贡献1,332LOT的1,185名患者中，985有标准的细胞遗传学风险(中位年龄，71岁)和180岁有高风险(中位年龄，69年）。与其他方案相比，DRd与总DOT较长相关(调整后的风险比[95%置信区间]：1.84[1.42,2.38]vs.KRd,1.65[1.20,2.28]vs.ERd,1.58[1.23,2.04]vs.IRd,和1.54[1.18,2.00]vs.VRd),和更长的TTNT和PFS。与DRd(1.45[1.01,2.08])和VRd(1.32[1.01,1.73])相比,KRd与较短的OS相关。高危患者在所有三联疗法中的结局相似。
结论：虽然DRd总体上改善了临床结局，含有PI或MAB的基于Rd的三联体方案在高风险RRMM中同样有效。
方法：启动IRd的成人RRMM患者的电子健康记录（2014年1月1日-2020年9月30日），KRd,VRd,ERd,或DRd在第二或以后的治疗线（LOT）进行了分析。索引日期是每个LOT的开始日期，基线是6个月的索引前阶段。治疗持续时间（DOT），下一次治疗时间（TTNT），无进展生存期（PFS），采用多变量Cox比例风险模型,比较了不同治疗方案和总生存期(OS).
结果：在贡献1,332LOT的1,185名患者中，985有标准的细胞遗传学风险(中位年龄，71岁)和180岁有高风险(中位年龄，69年）。与其他方案相比，DRd与总DOT较长相关(调整后的风险比[95%置信区间]：1.84[1.42,2.38]vs.KRd,1.65[1.20,2.28]vs.ERd,1.58[1.23,2.04]vs.IRd,和1.54[1.18,2.00]vs.VRd),和更长的TTNT和PFS。与DRd(1.45[1.01,2.08])和VRd(1.32[1.01,1.73])相比,KRd与较短的OS相关。高危患者在所有三联疗法中的结局相似。
结论：虽然DRd总体上改善了临床结局，含有PI或MAB的基于Rd的三联体方案在高风险RRMM中同样有效。
