【摘要】 目的：评估一线硼替佐米应用不耐受转换为卡非佐米治疗多发性骨髓瘤（MM）的可行性。方法：收集2023年3月至2025年1月在苏州大学附属第一医院和苏州弘慈血液病医院，一线硼替佐米为主三药方案应用期间出现≥1级伴疼痛周围神经病变（PN）等不耐受时转换为卡非佐米继续治疗MM患者的临床资料，回顾性分析其安全性和疗效。结果：共纳入23例MM患者，中位年龄63(46-75)岁。转换前硼替佐米的中位治疗周期为4(1-6)个；不耐受的原因中PN有22例，腹泻1例。中位随访时间10(2-23)个月，因PN转换者在转换卡非佐米后1月、2月和4月分别有1/22、3/22和12/20的患者PN症状下降1个等级，转换后4月时所有患者的疼痛症状均消失。转换2月后总体神经功能限制性评分（ONLS）和总神经病变评分表（TNS）积分较基线即有明显下降（P<0.001）。卡非佐米应用后≥3级中性粒细胞减少从21.7%降至17.4%(P=0.021)，新增非血液学毒性均为一过性，最常见为1-2级的高血压11/23例（47.8%）和QTcF延长3/23例（13.0%）。疗效分析上，转换后≥完全缓解率从30.4%提升至69.5%(P=0.047)、严格意义的完全缓解率和微小残留病变阴转率均从30.4%提升至65.2%(P=0.026)。结论：一线硼替佐米不耐受转换为卡非佐米能明显缓解PN等症状，同时可提高缓解深度。更多还原

【Abstract】 Objective:To evaluate the feasibility of in-class transition(iCT) first-line bortezomib intolerance to carfilzomib in the treatment of patients with multiple myeloma(MM).Methods:It was retrospectively collected that the clinical data of MM patients who transitioned to carfilzomib due to intolerance,such as≥grade 1 painful peripheral neuropathy(PN),during the treatment with first-line bortezomib-based triple regimens in the First Affiliated Hospital of Soochow University and Soochow Hopes Hematology Hospital from March 2023 to January 2025,and their safety and efficacy were analyzed.Results:A total of 23 MM patients were included.The cohort had a median age of 63(46-75) years.The median treatment cycle of bortezomib before iCT was 4(1-6).Among the causes of intolerance,there were 22 cases of PN and 1 case of diarrhea.With a median follow-up of 10(2-23) months,at 1 month,2 months and4 months,1/22,3/22,and 12/20 of patients reduced by one grade in PN after transition.At 4 months after transition,all patients ’ peripheral neuropathic pain symptoms had disappeared.After 2 months of transition,there was a significant decrease in overall neuropathy limitations scale(ONLS) and total neuropathy score(TNS) scores compared to baseline(P <0.001).After carfilzomib treatment,the decrease in grade≥3 neutropenia from 21.7% to 17.4%(P=0.021).The additional non-hematological toxicity was transient,with grade 1-2 hypertension(47.8%) and QTcF prolongation(13.0%).In terms of efficacy analysis,the conversion rate of≥CR increased from 30.4% to 69.5%(P=0.047),and the sCR rate and mininal residual disease(MRD) negative conversion rate both increased from 30.4% to 65.2%(P=0.026).Conclusion:The transition of first-line bortezomib intolerance to carfilzomib can significantly improve symptoms such as PN and deepen remission.更多还原