自体造血干细胞移植治疗多发性骨髓瘤疗效观察

Efficacy of autologous hematopoietic stem cell transplantation in patients with multiple myeloma

目的探讨自体造血干细胞移植(auto-HSCT)治疗多发性骨髓瘤(MM)的疗效及安全性。方法回顾性分析2007年10月至2020年7月空军军医大学第二附属医院收治的33例初治MM患者的临床特点及治疗效果。结果截至随访结束,所有患者中位随访时间为45(17~135)个月。移植前完全缓解(CR)17例、非常好的部分缓解(VGPR)6例、部分缓解(PR)10例,移植后3个月CR 22例、VGPR 8例、PR 2例、PD 1例。30例患者移植后3个月≥VGPR率为90.9%,明显高于移植前的69.7%,差异有统计学意义(P<0.05)。3年总生存率(OS)为74.5%,3年无进展生存率(PFS)为59.1%。诱导治疗≤4个疗程共18例,该组患者3年OS为77.3%,3年PFS为60.1%。诱导治疗>4个疗程共15例,该组患者3年OS为70.0%,3年PFS为58.9%。诱导治疗≤4个疗程组与>4个疗程组患者的3年OS及3年PFS比较差异无统计学意义(P>0.05)。患者治疗的主要不良反应为骨髓抑制、黏膜炎、肺炎。结论自体造血干细胞移植治疗对适合移植的MM患者有效,可进一步提高缓解率和缓解深度,延长患者的PFS和OS时间。

Objective To investigate the efficacy and safety of autologous hematopoietic stem cell transplantation(auto-HSCT)in patients with multiple myeloma(MM).Methods A retrospective analysis was performed in 33 newly diagnosed MM patients who were treated with bortezomib-based induction chemotherapy followed by auto-HSCT in the Second Affiliated Hospital of Air Force Medical University from October 2007 to July 2020.Results With a median follow-up of 45 months(in a range of 17 to 135 months),there were 17 cases of complete remission(CR)before transplantation,6 cases of very good partial remission(VGPR),10 cases of partial remission(PR).Three months after transplantation,there were 22 cases of CR,8 cases of VGPR,2 cases of PR,and 1 case of PD.The≥VGPR rate before and after auto-HSCT were 69.7%and 90.9%,and there was a statistically significant difference between the two groups(P<0.05).The 3-year overall survival(OS)was 74.5%and progression free survival(PFS)was 59.1%.A total of 18 cases had induction therapy≤4 courses,and the 3-year OS and the 3-year PFS of the patients were 77.3%and 60.1%,respectively.There were 15 cases of induction therapy>4 courses,and the 3-year OS and the 3-year PFS were 70.0%,58.9%,respectively.There was no significant difference in the 3-year OS and 3-year PFS between the induction therapy group with≤4 courses and the group with>4 courses(P>0.05).The main adverse complication was bone marrow suppression and infection.Conclusion Autologous hematopoietic stem cell transplantation is effective for MM patients suitable for transplantation,which can further improve the remission rate and depth,and prolong the PFS and OS time of patients.