硼替佐米联合地塞米松方案诱导后续不同方法巩固治疗多发性骨髓瘤长期疗效观察

A long-term observation on efficacy of consolidation treatments after bortezomib-dexamethasone induction therapy in multiple myeloma

目的比较以硼替佐米联合地塞米松(VD)方案诱导治疗达到完全缓解/接近完全缓解(CR/nCR)疗效的多发性骨髓瘤(MM)患者接受自体造血干细胞移植和VD方案作为不同巩固治疗的疗效和预后。方法回顾性分析2006年7月至2009年2月中山大学附属第一医院血液科23例经VD方案诱导达到CR/nCR疗效的MM患者的临床资料。16例(移植组)接受自体造血干细胞移植作为巩固,7例(非移植组)继续应用VD方案巩固2～4个疗程。两组患者巩固治疗后均接受50～200mg反应停维持治疗直至复发。结果移植组患者在巩固治疗后有7例患者(7/16,43.8%)疗效进一步增加,中位随访15个月时所有患者均存活,处于无疾病进展状态;非移植组在中位随访13个月时,2例患者疾病进展,再次诱导治疗无效死亡。VD方案不影响干细胞采集,所有患者的干细胞植入顺利,中位中性粒细胞恢复时间16d(10～30d),中位血小板恢复时间20d(9～100d)。VD方案的常见不良反应包括胃肠道(47.8%)、疲乏(26.1%)、血小板减少(26.1%)、周围神经炎(52.2%)和感染(26.1%),3～4级毒副反应发生率低。结论自体造血干细胞移植的地位仍不可替代,VD方案诱导化疗后以自体移植作为巩固,是治疗年轻MM患者的最佳选择。

Objective To investigate the therapeutic outcomes and prognosis in patients with muhiple myeloma （MM） who received autologous stem cell transplantation or bortezomib-dexamethasone （VD） therapy after having achieved complete remission or near complete remission （CR/nCR） induced by VD therapy. Methods Retrospective analysis was performed on the clinical data in 23 patients with multiple myeloma （MM） who have achieved CR/nCR after receiving VD induction therapy. 16 patients （transplantation.group） received autologous stem cell transplantation and 7 patients received VD therapy for 2 to 4 cycles as a consolidation therapy. Patients in both groups received thalidomide 50 -200 mg daily as a maintenance therapy until relapsing. Results During the follow-up for a median of 15 months,7 patients （7/16,43.8%） in the transplantation group experienced improved outcome of consolidation therapy. All patients survived and were progression-free. During the follow-up for a median of 13 months, however,2 patients in the non-transplantation group had disease progression and died after a secondary induction therapy. Stem cell collection was not affected by VD therapy and the stem ceils were implanted successfully in all patients. The median neutrophil recovery time was 16 days （range：10 to 30 days） and the median platelets recovery time was 20 days （range：9 to 100 days）. Adverse effects of VD therapy commonly included gastrointestinal reaction （ 47.8% ）, diarrhea （ 26. 1% ） , thrombocytopenia （ 26. 1% ） , peripheral neuritis （52. 2% ） and infection （26. 1% ）. Incidence rate of Grade 3 or 4 toxic reactions were rare. Conclusion The status of autologous stem cell transplantation in multiple myeloma remains irreplaceable. Autologous stem cell transplantation followed by VD induction may be the best choice for young patients with multiple myeloma.