不同化疗方案联合自体外周血造血干细胞移植治疗多发性骨髓瘤的疗效分析

Analysis of Curative Efficacy of Different Chemothe rapy Regimen Combined with Autologous Peripheral Blood Hematopoietic Stem Cell Transplantation on Multiple Myeloma

目的:探讨多发性骨髓瘤(multiple myeloma,MM)患者序贯化疗后自体外周血造血干细胞移植(autoPBHSCT)的疗效。方法:7例患者采用长春新碱+多柔吡星+地塞米松(VAD)、马法兰+强的松(MP)序贯化疗(A组)。B组14例新诊断患者采用硼替佐米+吡柔吡星+地塞米松(VTD)、硼替佐米+地塞米松(VD)方案进行序贯化疗。4-6个疗程后,采用化疗(环磷酰胺+足叶乙甙)+粒细胞集落刺激因子方法动员自体外周血造血干细胞,预处理方案分别为大剂量马法兰(A组)或硼替佐米+马法兰(B组),行auto-PBHSCT。移植后分别以重组人干扰素-α(A组)和沙利度胺(B组)维持治疗。结果:A组完全缓解(CR) 2例(2/7,28. 6%),非常好的部分缓解(VGPR) 1例(1/7,14. 3%),部分缓解(PR) 4例(4/7,57. 1%),B组CR9例(9/14,64. 3%),VGPR3例(3/14,21. 4%),PR2例(2/14,14. 3%),2组间疗效(CR+VGPR)差异显著(P <0. 05)。移植后2组患者均获得造血重建。2组患者中性粒细胞≥0. 5×109/L的中位时间分别为13(11-16)和14(11-18) d,白细胞≥4. 0×109/L的中位时间分别为16(15-19)和18(16-20) d,血小板≥50×109/L的中位时间分别为21(18-25)和21(17-25)d。21-28 d骨髓检查示完全缓解骨髓像。A组的7例患者在移植后6-47个月复发,4例最终死亡,3例失访,中位无进展生存(PFS) 36(6-47)个月,中位总生存(OS) 37(7-50)个月。B组有2例分别在移植后5和17个月复发后死亡,1例12个月复发后失访,1例移植后46月复发,后行第2次自体造血干细胞移植并达到CR,目前病情累计CR 105个月,余10例持续缓解,中位PFS为45. 5(4-105)个月,中位OS为45. 5(4-105)个月。2组间移植后PFS和OS有显著差异(P <0. 01)。结论:MM患者应用硼替佐米为主方案化疗后进行auto-PBHSCT,移植后给予沙利度胺维持治疗可延长患者PFS和OS时间。

Objective:To evaluate the efficacy of autologous peripheral blood hematopoietic stem cell transplantation (auto-PBHSCT)on patients with multiple myeloma(MM)after Sequential different chemotherapy.Methods:Seven cases of patients with MM were included in the A group,and 14cases of patients received 4-6courses of chemotherapy with VAD and MP before transplantation were included in the B group and received 4-6courses of chemotherapy with VTD and VD before transplantation.Auto,peripheral blood hematopoietic stem cell were mobilized by G-CSF.Condition regimen were melphalan(A group)or bortezomib combined melphalan(B group).IFN-α(A group)or Thalidomide(B group)was used as maintenance treatment after auto-PBHSCT.Results:Two cases of patients reached to complete remission (CR)(2/7,28.6%),1 case got very good partial remission (VGPR)(1/7,14.3%),4 cases got partial remission(PR)(4/7,57.1%)in A group,and 9cases got CR (9/14,64.3%),3 cases got VGPR(3/14,21.4%), and 2cases got PR(2/14,14.3%)in the B group before auto-PBHSCT.The CR and VGPR were significant difference between 2 groups (P<0.05).All the patients got hematopoietic recovery.In 2 groups,the median time of ANC recovery≥0.5× 10^9/L was 13(11-16)and 14(11-18)days,that of WBC recovery ≥4.0×10^9/L were 16(15- 19)and 18(16-20)days,Pit recovery ≥50×10^9/L was 21(18-25)and 21(17-25)days.Bone marrow showed CR in 21to 28days after transplantation.All of 7 cases of patients remised in 6 to 47 months after transplantation,and 4 cases died lastly and 3 cases failed to be followed up in A group.The median time of progression-free survival(PFS) was 36(6-47)months,and that of overall survival(OS)was 37(7-50) months.In B group,2 cases of patients remissed in 5 and 17 months after transplantation,and did lastly,1 case relieved in 12 months after transplantation and failed to be followed up.1 case of patient relived in 46 months after transplantation,and then received the second auto- PBHSCT,and got CR for 105 months.Other 10 cases got CR,their median time of PFS was 45.5(4-105) months, the median time of overall survival(OS)was 45.5(4-105) months.The PFS and OS were very significant different between 2 groups (P<0.01).Conclusion:Bortezomib-based chemotherapy,Auto-PBHSCT and maintenance treatment with thalidomide were favorable to the patients of MM for survival prolongation.