自体外周造血干细胞移植治疗21例多发性骨髓瘤的临床疗效及预后因素评价  

Analysis of therapeutic effect and prognosis of autologous peripheral stem cell transplanation for 21 patients with multiple myeloma

作　　者：刘辉[1] 常乃柏[1] 李江涛[1] 宁尚勇[1] 裴蕾[1] 程玮[1] 田园[1] 

机构地区：[1]卫生部北京医院血液科,北京100730

出　　处：《临床血液学杂志》2011年第2期145-147,共3页Journal of Clinical Hematology

摘　　要：目的:评价自体外周造血干细胞移植(APBSCT)治疗21例多发性骨髓瘤(MM)患者的临床疗效以及影响预后的相关因素。方法:21例MM患者中有2例患者复发后行2次APBSCT,因此共行APBSCT 23例次。5例患者在诱导治疗时采用硼替佐米(万坷)联合方案,其他患者多数采用长春新碱、阿霉素加地塞米松(VAD)方案诱导治疗。在诱导治疗后给予环磷酰胺(Cy)联合依托泊苷(VP-16)化疗加粒细胞集落刺激因子(G-CSF)动员造血干细胞。预处理方案采用马法兰(M)200mg/m2或M 140mg/m2联合VP-16 1 000mg及司莫司汀(BCNU)200mg。结果:动员后患者采集的单个核细胞(MNC)中位数为7.01×108/kg;CD34+细胞为6.26×106/kg。APBSCT后中性粒细胞恢复至>0.5×109/L的中位时间9(7～13)d。23例次移植后,8例(34.8%)获得完全缓解(CR),9例(39.1%)获得非常好的部分缓解(VGPR)。本组患者的中位生存期(OS)35个月,中位无进展生存期(PFS)22个月。Ⅲ期和Ⅱ期患者的OS及PFS均差异无统计学意义(均P>0.05)。取得CR加VG-PR组患者的中位生存期尚未达到,中位PFS 37个月;部分缓解(PR)组患者中位OS 37个月,中位PFS 18个月。结论:APBCST作为MM诱导后的强化治疗缓解率高,无病存活期长。硼替佐米诱导治疗续贯造血干细胞移植CR率有可能进一步提高。Objective：To evaluate the clinical efficiency and prognostic factors of autologous peripheral stem cell transplantation（APBSCT） for 21 cases of multiple myeloma（MM）.Method：Two of 21 patients relapsed after APBSCT,after that these two patients received the second APBSCT,thus there were 23 case-times APBSCT altogether.5 patients used bortezomib as induction therapy.Other patients were inducted with VAD regimen（vincristine,doxorubicin and dexamethasone）.21 patients were mobilized by combined chemotherapy（Cy＋VP-16） and G-CSF regimen.The conditioning regimen was melphalan（M） 200 mg/m2 or M 140 mg/m2 combined with VP-16 1 000 mg and carmustine（BCNU） 200 mg.Result：The amount of mononuclear cells（MNC） in harvest were 7.01×108/kg.CD34＋ cells in harvest were 6.26×106/kg.The mean time of neutrophil recovering to 0.5×109/L after APBSCT was 9 days（7~13 days）.After 23 times of APBSCT,8 of them（34.8%） achieved complete remission（CR） and 9（39.1%） received a very good partial remission（VGPR）.The median overall survival time（OS） of all the patients were 35 months.The median progression-free survival（PFS） period was 22 months.The OS and PFS had no statistically difference between stage Ⅲ and stage Ⅱ patients（P0.05）.The median OS did not reached in those patients achieved CR or VGPR.The median PFS was 37 months.The median OS and median PFS were 37 months and 18 month respectively in those patients achieved PR.Conclusion：APBSCT can improve the response and survival of MM patients.Bortezomib induction therapy followed by APBSCT can futher improve the CR rate.

关 键 词：多发性骨髓瘤 自体外周造血干细胞移植 硼替佐米 

分 类 号：R733.3[医药卫生—肿瘤]