早期序贯治疗联合ASCT对中高危多发性骨髓瘤的临床疗效及对PD-1/PD-L1、T细胞和B细胞功能的影响

Clinical Curative Effect of Early Sequential Therapy Combined with ASCT on Middle-and High-Risk Multiple Myeloma and its Effect on PD-1/PD-L1,T Cell and B Cell Function

目的:分析早期序贯治疗联合自体造血干细胞移植(ASCT)对中高危多发性骨髓瘤的临床疗效及对PD-1/PD-L1、T细胞和B细胞功能的影响。方法:选择2019年1月—2022年5月南阳市中心医院收治的90例中高危多发性骨髓瘤患者作为研究对象,依照随机信封法分为观察组和对照组。对照组患者采用常规化疗方案进行治疗,观察组在对照组的基础上采用早期序贯治疗联合ASCT方案干预和治疗。干预治疗半年后对患者临床疗效进行评估,治疗前及治疗后半年时检测外周血中CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、PD-1及PD-L1蛋白表达水平,检测受试者血清中T细胞相关细胞因子IFN-γ、TNF-α及B细胞相关抗体IgA、IgM和IgG水平情况。结果:观察组治疗临床疗效显著优于对照组,差异有统计学意义(χ^(2)=13.586,P<0.05);治疗后,两组患者血中CD3^(+)T细胞、CD4^(+)T细胞水平均显著升高,CD8^(+)T细胞水平显著降低,差异有统计学意义(t=7.299、2.521、12.629,P<0.05);治疗后,两组患者血清中PD-1及PD-L1蛋白均显著降低,差异有统计学意义(t=16.315、11.161,P<0.05);治疗后,两组患者血清中IFN-γ、TNF-α蛋白均显著升高,差异有统计学意义(t=30.046、32.084,P<0.05);治疗后,两组患者血清中IgA蛋白显著降低,IgM和IgG蛋白均显著升高,差异有统计学意义(t=47.013、50.959、27.694,P<0.05)。结论:联合早期序贯治疗联合ASCT对中高危多发性骨髓瘤患者干预可有效提高临床疗效,控PD-1及PD-L1水平,改善T细胞和B细胞功能。

Objective:To analyze the clinical curative effect of early sequential therapy combined with ASCT on middle-and high-risk multiple myeloma and its effect on PD-1/PD-L1,T cell and B cell function.Methods:A total of 90 patients with middle-and high-risk multiple myeloma who were treated from January 2019 to May 2022 were selected,and divided into observation group and control group according to the random envelope method.On the basis of intervention and treatment,early sequential therapy combined with ASCT was adopted;the clinical efficacy of patients was evaluated half a year after the intervention;CD3^(+)T cells,CD4^(+)T cells,and CD8^(+)T cells,PD-1 and PD-L1 protein expression levels in peripheral blood were detected before treatment and half a year after treatment;the levels of T cell-related cytokines IFN-γ,TNF-αand B cell-related antibodies IgA,IgM and IgG in the serum of the subjects were detected.Results:The clinical curative effect of the observation group was significantly better than that of the control group(χ^(2)=13.586,P<0.05).After treatment,blood levels of CD3^(+)T cells and CD4^(+)T cells were significantly increased,while CD8^(+)T cells were significantly decreased,with statistically significant difference(t=7.299,2.521,12.629;P<0.05).After treatment,serum PD-1 and PD-L1 proteins in 2 groups were significantly decreased,and the difference was statistically significant(t=16.315,11.161;P<0.05).After treatment,serum IFN-γand TNF-αproteins in 2 groups were significantly increased,with statistically significant difference(t=30.046,32.084;P<0.05).After treatment,the serum IgA protein was significantly decreased,while IgM and IgG protein were significantly increased in both groups,with statistically significant difference(t=47.013,50.959,27.694;P<0.05).Conclusion:Early sequential therapy combined with ASCT can effectively improve the clinical efficacy,regulate the levels of PD-1 and PD-L1,and improve the functions of T cells and B cells after intervention in patients with intermediate and high-risk multiple myeloma.