30例自体外周造血干细胞移植治疗多发性骨髓瘤的疗效及预后因素评价

Analysis of therapeutic effects and prognostic factors of autologous peripheral stem-cell transplantation for 30 patients with multiple myeloma

目的:对30例多发性骨髓瘤(multiple myeloma,MM)患者经自体外周造血干细胞移植(autologous hematopoietic stemcell transplantation,APBSCT)治疗后的临床疗效进行评估,并分析可能影响预后的因素。方法:30例MM患者有2例复发行2次APBSCT,因此共计移植32例次。移植前予常规联合化疗(11例含万珂),化疗联合G-CSF动员APBSC,选择以马法兰为基础的预处理方案,d0天回输。结果:动员后患者采集的单个核细胞(MNC)中位数为6.41×108/kg,CD34+细胞4.75×106/kg。APBSCT后中位中性粒细胞和血小板重建时间分别为9.5天和11天。APBSCT后CR和VGPR率分别为37.5%和34.4%,中位生存期(overall surviv-al,OS)为67.27个月,中位无进展生存期(progression-free survival,PFS)为29.77个月,其中CR组、PR组中位PFS分别为29个月、20个月,VGPR组中位PFS未达到,CR+VGPR组与PR组PFS比较P=0.025。万珂组和非万珂组CR率分别为63.6%和23.8%(P=0.034),万珂组中位OS及PFS均未达到,非万珂组中位PFS为22个月(P=0.045)。结论:硼替佐米诱导序贯APBSCT可获得更长的无病生存。APBSCT作为MM诱导缓解后的强化治疗,缓解率高,且移植后获得VGPR以上反应的患者PFS获益。

Objective：To evaluate the clinical efficiency and prognostic factors of autologous peripheral blood stem cell trans-plantation （APBSCT） in 30 cases of multiple myeloma （MM）. Methods：Two of the 30 patients received the second treatment of APB-SCT because of relapse after the first treatment. Thus, a total of 32 case-times of APBSCT were studied. Combination chemotherapy was inducted regularly before APBSCT （11 patients used bortezomib as an induction drug）, and chemotherapy combined with the G-CSF regimen was used to mobilize peripheral blood stem cells. Preconditioning was based on melphalan. Results：Mononuclear cells in harvest were 6.41 × 10^8/kg, and CD34＋cells in harvest were 4.75 × 10^6/kg. The median times of neutrophil and platelet engraftment were 9.5 and 11 d, respectively. The complete remission （CR） and very good partial remission （VGPR） rates were 37.5%and 34.4%af-ter APBSCT, respectively. The median overall survival （OS） was 67.27 months in all patients, and the median progression-free survival （PFS） was 29.77 months. The median PFS rates were 29 and 20 months in the patients who achieved CR and PR, respectively, and the median PFS was not observed in the patients who achieved VGPR. Statistical differences in PFS were detected between the CR＋VGPR and PR groups （P=0.025）. The CR rates were 63.6%and 23.8%in the bortezomib （bortezomib-based chemotherapy） and non-bortezo-mib groups （P=0.034）, respectively. The median OS and PFS were not obtained in the bortezomib group, whereas the median PFS was 22 months in the non-bortezomib group （P=0.045）. Conclusion： MM patients treated with bortezomib-based chemotherapy followed by APBSCT had prolonged PFS. APBSCT can improve the response and survival of MM patients.