造血干细胞移植治疗16例多发性骨髓瘤疗效分析

The Analysis of Curative Effect on Hemapoietic Stem Cell Transplantation of 16 Patients with Multiple Myeloma

目的:评价造血干细胞移植(SCT)治疗多发性骨髓瘤(MM)患者的疗效。方法:回顾性分析我院SCT治疗16例D-S分期Ⅲ期MM患者。自体造血干细胞移植(ASCT)13例。2例原发耐药、2例ASCT后复发和1例高危患者接受HLA匹配同胞供者异基因造血干细胞移植(allo-SCT);其中4例应用清髓性预处理。采用NCI/SWOG(2004年前)和EBMT标准分析治疗反应。结果:共完成ASCT20例次,无移植相关死亡(TRM)。ASCT后均有效,9例获得完全缓解(CR),4例部分缓解(PR)。10例移植前CR/PR者,中位随访35(6～126)个月,3例复发/进展,中位总生存(OS)尚未达到[已超过35(6～119)个月],中位无进展生存(PFS)27(1～50)个月。3例ASCT前处于疾病稳定状态(SD)者分别于移植后11、7和5个月后复发/进展。Allo-SCT组1例预处理后早期TRM,余3例CR,1例PR。1例患者移植后4个月死于急性移植物抗宿主病(GVHD)合并严重肺感染;余3例生存分别已达39、41和14个月,其中仅后者仍持续PFS。结论:ASCT治疗MM耐受性好,能明显延长PFS和OS;原发难治患者ASCT仍有效,但PFS持续时间短暂。沙利度胺联合治疗用于移植前/后可能提高疗效。allo-SCT有效提高高危及复发/难治患者的治疗反应率。

Objective： To evaluated the curative effect of hemopoietic stem cell transplantation （HSCT） for patients with a multiple myeloma （MM）. Mehods： A retrospective analysis of 16 patients with a stage-Ⅲ Durine-Salmon multiple myeloma （MM）, treated with HSCT, was conducted. Thirteen patients received autologous stem cell transplantation （ASCT）. Besides, 2 patients with a primary and refractory symptom, 2 with a post-ASCT recurrence and 1 with high-risk MM received allogeneic stem cell transplantation （allo-SCT） from matched siblings, among which 4 received conventional myeloablative allogeneic transplantation. Therapeutic reactions to the transplantations were evaluated based on the criteria of NCI/SWOG （before 2004） and EBMT. Results： A total of 20 case-times of ASCT have been completed, without transplantation-related mortality （TRM）. All patients have reaction of the AS-CT, with complete remission （CR） in 9 patients and partial remission （PR） in 4. After a 35-month median follow-up （ranging from 6 to 126 months） was conducted for 10 of the 13 patients with a response to chemotherapy before ASCT, and relapse/progression occurred in 3 patients, the median overall survival （OS） have not been obtained （beyond 35 months now [ranging from 6 to 119 months]） and the median event-free survival （EFS） reached 27 months. Relapse or progression occurred in 3 cases, with stable disease （SD） before ASCT, 11, 7 and 5 months after transplantation, respectively. In the Allo-SCT group, early TRM occurred in 1 cases after pretrealment, complete response （CR） in the other 3, and partial response （PR） in 1. One of the cases died of acute graft-versus-host disease （GVHD） and seri-ous pneumonia 4 months after transplantation, and survival rates of the other 3 were 39, 41 and 14 months, respectively, among which EFS remained in the last patient. Conclusion： Our data shows that the ASCT is a safe and feasible treatment on the MM, which can significantly prolong the EFS and OS. Although ASCT is a useful salvage therapy for refractory MM, the EFS is transient. Thalidomide-based treatment, before and after ASCT, can improve the OR, PFS and OS. Allo-SCT may have a good therapeutic reaction on the patients with high-risk, relapse and refractory symptoms.