自体外周血造血干细胞移植联合硼替佐米及大剂量美法仑治疗多发性骨髓瘤3例

Autologous peripheral blood hemopoietic stem cell transplantation in combination with bortezomib and high-dose melphalan for multiple myeloma in 3 cases

背景:自体外周血造血干细胞移植联合大剂量化疗能明显提高多发性骨髓瘤患者完全缓解率和生存率,但复发率较高。硼替佐米是26S蛋白酶体抑制剂,对初治多发性骨髓瘤具有显著疗效。目的:评价自体外周血造血干细胞移植联合硼替佐米及大剂量美法仑对多发性骨髓瘤患者的疗效。方法:回顾性分析2006-10/2007-05贵阳医学院附属医院血液科收治的3例多发性骨髓瘤患者,均采用化疗加粒细胞集落刺激因子方案进行自体外周血造血干细胞的动员。于移植前3d静脉滴注美法仑200mg/m2作为预处理方案,停药48h后回输自体外周血造血干细胞。结果与结论:3例患者均获造血重建,细胞移植后30d骨髓抑制恢复正常,骨痛改善。细胞移植后,第1,2例患者获得完全缓解,第3例患者获得部分缓解。提示自体外周血造血干细胞移植联合硼替佐米及大剂量美法仑是治疗多发性骨髓的有效手段,患者对预处理方案耐受性较好。

BACKGROUND： Autologous peripheral blood hemopoietic stem cell transplantation （HSCT） in combination with high-dose chemotherapy significantly improves complete remission and survival rate of multiple myeloma patients. However, the relapse rate is high. Bortezomib is 26S proteasomes inhibitor, and effective on the primary treatment of multiple myeloma. OBJECTIVE： To evaluate the curative effect of HSCT in combination with bortezomib and high dose-melphalan for multiple myeloma. METHODS： A retrospective analysis of 3 patients with a stage-Ⅲ multiple myeloma admitted to Department of Hematology, Affiliated Hospital of Guiyang Medical College from October 2006 to May 2007, was conducted. Chemotherapy and granulocyte colony-stimulating factor were used to mobilize autologous peripheral blood hemopoietic stem cells. All patients were pretreated with 200 mg/m2 melphalan via intravenous drip 3 days before transplantation, followed by HSCT 48 hours after drug termination. RESULTS AND CONCLUSION： All patients obtained prompt and sustained hematopoietic reconstitution, and bone marrow depression restored 30 days following HSCT. Case 1 and 2 obtained complete remission, and case 3 obtained partial remission. Results show that HSCT in combination with bortezomib and high-dose melphalan is a safe and feasible treatment on multiple myeloma. The patients have good tolerance to pretreatment.