Multipl miyelomda Anti-CD38 monoklonal antikoru daratumumab tedavisi genel yanıt oranını arttırır

Öz

Amaç: Son yıllarda kullanılan yeni ilaçlar Multipl Miyelom (MM) hastalığında sağkalım oranlarında önemli artışlara yol açmıştır. CD38’e karşı geliştirilmiş monoklonal antikor olan Daratumumab hem birinci basamak miyelom tedavisinde hem de nükseden/dirençli hastalıkta kullanılmaktadır. Çalışmamız, merkezimizde daratumumab monoterapisi veya kombinasyon tedavisi alan hastaların klinik özelliklerini, tedaviye yanıt ve yanıtı etkileyen faktörleri değerlendirmeyi amaçlamaktadır. Gereç ve yöntem: Pamukkale Üniversitesi Tıp Fakültesi Hematoloji kliniğinde Haziran 2022 ile Haziran 2023 tarihleri arasında multipl miyelom tansı ile takip edilen ve daratumumab tedavisi alan 21 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, evreleri, daha önce aldıkları tedaviler, daratumumab tedavisinin özellikleri ve tedaviyle elde edilen yanıt oranları retrospektif olarak incelendi. Bulgular: Hastaların ortanca yaşı 65±9,7 yıl (42-80), kadın/erkek oranı 11/10 idi. Daratumumab tedavisi hastaların %61,9’da iki basamak tedavi sonrasında, %23,8’inde birinci basamak tedavide ve %14,28’de ikinci basamak tedavide kullanıldı. Ortalama siklus sayısı 4,05±5,06 idi. Daratumumab ile tedavi edilen hastaların %4,76’sında tek ajan, %61,9’u immünomodülatör ilaçlar, siklofosfamid ve/veya melfalan ile kombinasyon halinde ve %33,4’ü ise kemoterapi ile kombinasyon halinde kullanıldı. Tedaviye yanıt değerlendirildiğinde; hastaların %38,1'inin kaybedildiği, %38,1'inin çok iyi kısmi yanıt (ÇİKY) ve üzeri yanıt ile %23,8'inin stabil hastalık (SH) ile tedaviye devam ettiği görüldü. Kemoterapiyle birlikte daratumumab alan hastaların %42,9’u kaybedildi. Daratumumab içeren rejimler ile kür sayısı arttıkça genel yanıt oranlarının anlamlı bir şekilde arttığı görüldü (p=0,026). Sonuç: Multiple miyelom tedavisinde daratumumab içeren protokoller kullanıldığında kür sayısı ile doğru orantılı olarak genel yanıt oranlarının iyileştiği ve tedavi başarısının arttığı görülmüştür.

Anahtar Kelimeler

• Daratumumab
• multiple miyelom
• tedavi

Anti-CD38 monoclonal antibody daratumumab enhances the overall response rate in patients with multiple myeloma

Öz

Purpose: New medicines employed in recent years have resulted in significant increases in survival rates for Multiple Myeloma (MM). Daratumumab, a monoclonal antibody against CD38, is utilized in both first-line myeloma treatment and relapsed/refractory illness. Our study aims to assess the clinical features, response to treatment and factors influencing response to treatment in patients who received daratumumab monotherapy or combination therapy at our center. Materials and methods: In the Pamukkale University Faculty of Medicine Hematology clinic between June 2022 and June 2023, 21 patients who were treated with daratumumab after receiving a multiple myeloma diagnosis were included. Demographic features of the patients, disease stage, prior therapies, characteristics of daratumumab treatment, and response rates to treatments were retrospectively analyzed. Results: The patients median age was 65±9.7 years (42-80), with a female/male ratio of 11/10. Treatment with daratumumab: 61.9% was used after two lines of therapy, 23.8% was used in first-line therapy, and 14.28% was used in second-line therapy. The average number of cycles was 4.05±5.06. Of the patients treated with daratumumab, 4.76% were treated as a single agent; 61.9% were treated in combination with immunomodulatory medications, cyclophosphamide and/or melphalan; and 33.4% were treated in conjunction with chemotherapy. When the response to treatment was evaluated, 38.1% of the patients passed away, 38.1% had a very good partial response (VGPR) or better, and 23.8% had a partial response (PR). 42.9% of patients who received daratumumab along with chemotherapy died. With daratumumab-containing regimens, overall response rates increased significantly as the number of cycles increased (ORR) (p=0.026). Conclusion: When daratumumab-containing protocols are used in the treatment of multiple myeloma, it has been observed that overall response rates improve and treatment success increases in direct proportion to the number of cures.

Anahtar Kelimeler

• Daratumumab
• multiple myeloma
• treatment

Kaynakça

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