二次自体造血干细胞移植治疗高危多发性骨髓瘤的疗效观察

Curative efficacy of tandem autologous hematopoietic stem cell transplantation for high risk multiple myeloma

目的探讨二次自体造血干细胞移植(autologous hematopoietic stem cell transplantation,ASCT)治疗高危多发性骨髓瘤(high risk multiple myeloma,HRMM)的疗效。方法回顾性分析2017年1月至2021年12月在宁波大学附属第一医院和河南省人民医院血液科初诊的240例HRMM患者的临床资料。根据诱导化疗后治疗方式的不同,进一步将患者分为二次ASCT组(20例)、单次ASCT组(80例)和未移植组(140例),比较诱导化疗后深度缓解[疗效在非常好的部分缓解(very good partial response,VGPR)及以上]率及3组间2年无进展生存率(progression free survival,PFS)和总生存率(overall survival,OS)的差异。并通过单因素和多因素分析影响HRMM预后的相关因素。结果①单次ASCT组诱导化疗后和移植后的深度缓解率分别为67.50%(54/80)和80.00%(64/80),前后比较,差异没有统计学意义(P=0.072)。二次ASCT组诱导化疗后和移植后的深度缓解率分别为65.00%(13/20)和95.00%(19/20),前后比较,差异有统计学意义(P=0.018)。②二次ASCT组、单次ASCT组、未移植组患者2年PFS分别为75.00%±2.90%、71.25%±3.00%和61.43%±3.10%。未移植组和二次ASCT组与单次ASCT组2年PFS比较,差异均无统计学意义(P=0.365和0.052),二次ASCT组与未移植组2年PFS比较,差异有统计学意义(P=0.032)。二次ASCT组、单次ASCT组、未移植组的2年OS分别为90.00%±3.50%、78.75%±2.70%和62.86%±2.50%。未移植组和二次ASCT组与单次ASCT组2年OS比较,差异均无统计学意义(P=0.071和0.057),二次ASCT组与未移植组2年OS比较,差异有统计学意义(P=0.003)。③单因素和多因素分析结果显示,多重打击、R-ISSⅢ期、诱导4疗程后疗效未达VGPR、未行二次ASCT是PFS的独立预后影响因素。多重打击、R-ISSⅢ期、未行二次ASCT是OS的独立预后影响因素。结论二次ASCT不仅可以明显提高HRMM患者的深度缓解率,且可进一步提高HRMM患者的2年PFS和OS,是值得推荐的一种治疗模式。

Objective To explore the curative efficacy of tandem autologous stem cell transplantation(ASCT)for high-risk multiple myeloma(HRMM).Methods From January 2017 to December 2021,retrospective analysis was conducted for 240 initially diagnosed HRMM patients.According to different treatment protocols after induction chemotherapy,they were further assigned into three groups of tandem ASCT(n=20),single ASCT(n=80)and non-transplantation(n=140).Rates of deep response(very good partial response and above)before and after transplantation and differences in 2-year progression-free survival(PFS)and overall survival(OS)were compared among three groups.The prognostic factors of HRMM were examined by univariate and multivariate analyses.Results In single ASCT group,the rates of deep responses were 67.50%(54/80)after induction chemotherapy and 80.00%(64/80)post-ASCT(P=0.072).There were no significant statistical differences.In tandem ASCT group,the rates of deep response were 65.00%(13/20)after induction chemotherapy and 95.00%(19/20)post-ASCT(P=0.018).There were significant statistical differences.The 2-year PFS of tandem ASCT,single ASCT and non-transplantation groups were(75.00±2.90)%,(71.25±3.00)%and(61.43±3.10)%respectively.No statistically significant difference existed in 2-year PFS rates between single ASCT and non-transplantation groups,as well as between tandem ASCT and single ASCT groups(P=0.365 and P=0.052).Significant difference existed in 2-year PFS between tandem ASCT and non-transplantation groups(P<0.032).Two-year OS rates of tandem ASCT,single ASCT and non-transplantation groups were(90.00±3.50)%,(78.75±2.70)%and(62.86±2.50)%respectively.No statistically significant difference existed in 2-year OS rate between single ASCT and non-transplantation groups,as well as between tandem ASCT and single ASCT groups(P=0.071 and P=0.057).Significant difference existed in 2-year OS between tandem ASCT and non-transplantation groups(P=0.003).Univariate and multivariate analyses indicated that the independent prognostic factors affecting PFS were multi-hit,stages RISS-Ⅲand failure to achieve very good partial response(VGPR)after four cycles of induction therapy and non-tandem ASCT.The independent prognostic factors affecting OS were multi-hit,stages RISS-Ⅲand non-tandem ASCT.Conclusion Tandem ASCT not only significantly improves the depth of remission but also further enhances 2-year PFS/OS of HRMM patients.It is a recommended treatment for HRMM.