依托泊苷联合环磷酰胺用于多发性骨髓瘤自体外周血造血干细胞动员的疗效和安全性分析

Efficacy and Safety of Etoposide Combined with Cyclophosphamide for Autologous Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma

目的:探讨依托泊苷联合环磷酰胺(EC)方案用于多发性骨髓瘤(MM)患者自体外周血造血干细胞动员的有效性及安全性。方法:回顾性分析2015年1月至2021年10月南昌大学第一附属医院血液科48例行自体外周血造血干细胞移植的MM患者的临床资料,统计EC方案的动员成功率、优质动员率以及对MM患者移植疗效、不良反应、移植后造血重建和生存时间的影响。结果:患者EC方案结束后14(10-19)d开始采集自体外周血造血干细胞,CD34^(+)细胞采集中位数为6.82(1.27-22.57)×10~6/kg,中位采集数2(1-4)次,动员成功率为98%(47/48),优质动员率为71%(34/48)。患者移植后缓解深度提高,完全缓解率从移植前的45.8%提升至移植后的87.5%(P<0.01)。无移植相关死亡,动员期间无需输血治疗,未发生黏膜炎。常见的不良反应为中性粒细胞缺乏,发生率为75.0%(36/48)。患者移植后均顺利获得造血重建,白细胞植入中位时间为10(9-26)d,血小板植入中位时间为10(8-33)d。截止末次随访,患者中位无进展生存期和中位总生存期均未达到,5年估算无进展生存率和总生存率分别为53.8%和82.4%。结论:EC方案采集成功率高,不良反应可控,是一种安全有效的MM患者干细胞动员方法。

Objective:To evaluate the efficacy and safety of etoposide combined with cyclophosphamide(EC)regimen for mobilization of autologous peripheral blood stem cells(APBSCs)in patients with multiple myeloma(MM).Methods:The clinical data of 48 MM patients who received APBSC transplantation(APBSCT)in Department of Hematology of the First Affiliated Hospital of Nanchang University from January 2015 to October 2021 were retrospectively analyzed.The mobilization success rate and mobilization optimal rate of EC regimen were counted,and its effect on transplant efficacy,adverse reactions,hematopoietic reconstitution after transplantation,and survival time of MM patients were analyzed.Results:APBSCs were collected on day 14(10-19)after EC administration.The median of collected CD34^(+)cells was 6.82(1.27-22.57)×10^(6)/kg,and the median number of apheresis session was 2(1-4).The mobilization success rate(collecting CD34^(+)cells≥2×10^(6)cells/kg after completion of apheresis)was 98%(47/48),and mobilization optimal rate(collecting CD34^(+)cells≥5×10^(6)cells/kg after completion of apheresis)was 71%(34/48).The depth of remission were improved after APBSCT,and the complete remission(CR)rate increased from 45.8%before transplantation to 87.5%after transplantation(P<0.01).There was no transplant-related death,no blood transfusion during mobilization,and no mucositis occurred in the patients.The most common complication was neutropenia,with an incidence of 75.0%(36/48).After transplantation,all the patients successfully achieved hematopoietic reconstitution.The median time to neutrophil engraftment was 10(9-26)days,and median time to platelet engraftment was 10(8-33)days.By the end of follow-up,both the median progressionfree survival(PFS)and overall survival(OS)time were not reached.The 5-year estimated PFS rate and OS rate was 53.8%and 82.4%,respectively.Conclusion:The EC regimen for mobilization of APBSC has a high acquisition success rate and controllable adverse reactions,which can be an effective and safe mobilization regimen in MM patients.