Bortezomib « bihebdomadaire » versus « hebdomadaire » dans le traitement du myélome multiple en première ligne

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Docteur BENDAHMANE Ahmed Fouad
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Introduction: The management of multiple myeloma (MM) has improved significantly in recent years. The results obtained by triplet induction in the first line and the advent of new molecules have led to significant progress in young patients under 65 years of age. Current treatment regimens include induction therapy combining a proteasome inhibitor, an immunomodulator and corticosteroids. The bi-weekly bortezomib injection rate, combined with CSH infusion therapy and post-transplant (consolidation and maintenance), increased response rates (CR and VGPR) and survival time. In the context of a prospective work, we evaluated the response to the induction of the two protocols with the main objective of showing that the weekly injection is safer and / or easier to use, but without loss of 'efficiency. Patients and methods: This is a prospective, controlled, evaluation study of two methods of administering bortezomib in patients younger than 66 years of age with de novo MM. The first method is a bi-weekly regimen of 1.3mg / m 2, J1-J4-J8-J11 one cycle every 21 days and the second method on a weekly schedule at 1.3 mg / m 2, J1-J8-J15-J22, one cycle every 28 days. An assessment is performed after 4 cycles in search of CR or TBRC or PR. Results: This study covered a period of two years of inclusion (January 2016-December 2017). 80 patients (pts) were collected from Hematology Department of Tlemcen University Hospital divided into two groups of 40pts. The sex ratio is 1.58. The median age at diagnosis is 55.6 years (38-65). The monoclonal component is of IgG type in 51% of pts, Kappa light chain in two thirds of patients. The majority of the pts are stage IIIA (78%) and 76% stage ISS II and III. The overall response to induction in group A is identical to that of group B (95% versus 92.5%), of which 12% versus 10% of CR, 45% versus 45% of VGPR and 37% versus 37% of RP. After a median follow-up of 23 months (6 - 38 months), disease-free survival (DFS) is 55% at 28 months, progression-free survival (PFS) at 60.5% at 21 months, and overall survival (OS) from 61% to 33 months. The search for prognostic factors, according to the clinical stage, or the renal insufficiency or the type of the monoclonal component was negative. The haematological and extra-haematological toxicity profile (neurological toxicity) is acceptable 64% versus 62%.