Abstract
Background: The treatment strategies of plasma cell myeloma have been changed after the introduction of novel agents, such as immunomodulatory drugs (thalidomide and lenalidomide) and proteasome inhibitors (bortezomib) in the past few years. However, the impact of novel agents in the Taiwanese population is not yet well documented. In this retrospective study, we tried to clarify the impact of novel agents and identify the prognostic factors. Methods: Between November 2000 and December 2009, 118 myeloma patients were newly diagnosed at the Kaohsiung Veterans General Hospital. We analyzed the manifestations, characteristics, treatments, and outcomes of these patients. Results: Totally, 88 men (74.6%) and 30 women (25.4%) were enrolled. 13.6% (n=16), 7.6% (n=9), and 78.8% (n=93) of patients were classified into Durie-Salmon system stage Ⅰ, Ⅱ and Ⅲ. 42.7% of patients received chemotherapy containing melphalan plus prednisone (MP), 33.1% received vincristine, anthracycline and dexamethasone (VAD), 23.7% received thalidomide-based, and 10.8% received bortezomib-based regimens during the whole course. Patients who received MP-containing, thalidomide-based, and bortezomib-based regimens had superior overall survival (p=0.0022, 0.0034, and 0.0359, respectively), in contrast to those receiving VAD (p=0.1124). Except better performance in patients with VAD (p=0.031), no significantly different characteristic was demonstrated in the subgroups with or without VAD. In the multivariate analysis of overall survival, high C-reactive protein (Hazard ratio 5.065; 95% of CI 2.289-11.209; p=0.000), no thalidomide (Hazard ratio 0.320; 95% of CI 0.126-0.812; p=0.017), and no MP (Hazard ratio 0.177; 95% of CI 0.066-0.478; p=0.001) proved to be independent poor prognostic factors. Conclusions: In the era of novel agents, chemoregimens containing MP still work and thalidomide plays an important role in the treatment of myeloma. Due to the limited number of enrolled patients who received bortezomib, the efficacy of bortezomib may be underestimated and long-term follow-up with larger scale studies are warranted to validate the results.
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