自体造血干细胞移植治疗多发性骨髓瘤的疗效分析

Analysis of therapeutic effect of autologous hematopoietic stem cell transplantation on the treatment of multiple myeloma

目的:评价自体造血干细胞移植(APBSCT)治疗多发性骨髓瘤(MM)的临床疗效。方法:对25例Durie-Salmon分期为ⅡA~ⅢB期的MM患者行化疗联合APBSCT,其中5例患者预处理方案中在马法兰基础上加用硼替佐米,随访分析移植后反应率及生存情况。结果:25例患者均获得造血重建,中性粒细胞植入中位时间为15(8~26)d,血小板植入中位时间为22(11~50)d,移植相关并发症包括发热9例,其中肺部感染4例,移植相关病死率为0。25例患者均于移植后1个月全面评估,16例(64%)达到完全缓解,5例(20%)达到非常好的部分缓解,4例(16%)达到部分缓解,总体有效率为100%。中位随访30(2~70)个月,8例复发,其中3例经二次移植后达到完全缓解,5例经再次诱导后获得完全缓解。最终4例死于肺部感染。25例移植后中位无进展生存期为42个月。结论:APBSCT是治疗MM相对有效和安全的方法,鉴于前期诱导及移植前预处理方案中加入硼替佐米的优越性尚需进一步探讨。

Objective:To evaluate the clinical efficacy of autologous hematopoietic stem cell transplantation(APBSCT)on the treatment of multiple myeloma(MM).Method:Twenty five MM patients at Durie Salmon stagingtⅡA toⅢB were treated with chemotherapy combined APBSCT,five patients received melphalan and bortezomib as conditioning regimen.The response rate and survival after transplantation were followed up.Result:All 25patients got hematopoietic recovery successfully,neutrophile implanted median time was 15(8to 26)days,platelet implanted median time was 22(11to 50)days.The main transplant related complications included fever in 9cases,of which 4cases were pulmonary infection,transplantation related mortality rate was 0.Assessment was taken one month after transplantation in all 25cases,16cases(64%)got CR,5cases(20%)got VGPR,4patients(16%)got PR,with an overall response rate 100%.Median follow-up time was 30(2to 70)months.8patients relapsed and 3of them were treated with secondary transplantation to get CR,5patients received chemotherapy to get CR.At last,4cases died of lung infection.Median PFS time was 42months after transplantation.Conclusion:APBSCT is a relatively safe and effective method for treating MM.The advantage of adding bortezomib in induction and conditioning regiment remains to be further discussed.