白消安、环磷酰胺、足叶乙甙预处理在多发性骨髓瘤自体造血干细胞移植中的应用  

Busulfan, cyclophosphamide and etoposide as conditioning for autologous stem cell transplantation in multiple myeioma

作　　者：张春阳[1] 傅卫军[1] 奚昊[1] 周莉莉[1] 姜华[1] 杜鹃[1] 樊建玲[1] 李荣[1] 金丽娜[1] 曾添美[1] 侯健[1] 

机构地区：[1]第二军医大学长征医院血液科、全军骨髓瘤与淋巴瘤疾病中心,上海200003

出　　处：《中华血液学杂志》2013年第4期313-316,共4页Chinese Journal of Hematology

摘　　要：目的评价BCV（白消安＋环磷酰胺＋足叶乙甙）预处理方案在多发性骨髓瘤（MM）自体造血干细胞移植（ASCT）患者的疗效和安全性。方法2007年9月至2010年9月采用大剂量马法兰对32例MM患者行ASCT预处理（HDM组），中位年龄53．5（30～63）岁；2010年10月至2012年10月采用BCV方案（白消安静脉给药、总剂量9．6mg／kg）对38例MM患者行ASCT预处理（BCV组），中位年龄54（35—64）岁。结果两组患者MM分型、Durie—Salmon分期、国际分期体系（ISS）分期及接受一、二、三线以上治疗患者比例差异均无统计学意义。BCV组与HDM组比较，中性粒细胞植入时间[10．5（9—15）d对11（9～27）d，P：0．057]和血小板植入时间[11（9—210）d对12（10-45），P=0．100]，差异均无统计学意义。两组患者预处理不良反应相似，无肝静脉阻塞病和移植早期死亡发生。BCV组、HDM组患者ASCT后完全缓解率（分别为63．18％、59．38％）均高于ASCT前（分别为44．74％、37．50％）。BCV组中位随访16（2～27）个月，10例（26．32％）患者出现疾病进展，1年无进展生存率为71．37％。结论含减低剂量白消安针剂的BCV方案对于MM患者是安全、有效的ASCT预处理方案，其远期疗效尚待长期随访观察。Objective To evaluate the efficacy and safety of dose-reduced intravenous busulfan, cy- clophosphamide and etoposide （BCV） as conditioning for autologous stem cell transplantation （ASCT） in multiple myeloma （MM）. Methods From September 2007 to September 2010, thirty-two ASCT-eligible patients with MM received high dose melphalan （HDM） as conditioning in our center. Median age was 53.5 （30 -63） years. From October 2010 to October 2012, thirty-eight patients conditioned by BCV regimen （intravenous busulfan, total doses 9.6 mg/kg）, whose median age was 54 （ 35 - 64） years. Results There were no statistical differences in clinical characteristics between the two groups, including myeloma isotype, Durie-Salmon staging, international staging system（ ISS）, and patients received the first line, second line or more than third line therapy. The median time to neutrophil and platelet engraftment were 10.5 vs 11 days （P =-0. 057） and 11 vs 12 days （P = 0. 100） in the BCV and HDM groups, respectively. The toxicity of two conditioning regimens had no significant difference. None of hepatic veno-oeclusive disease and early transplant related mortality was observed. Although overall response rates showed no significant difference between two groups （ P 〉 0.05 ）, the CR rates increased from 44.74% pre-ASCT to 63.18% post-ASCT in the BCV group, while 37.50% to 59.38% in the HDM group. During the median follow-up of 16 months （range 2 - 27） in BCV group, ten patients （26. 32% ） developed progressive disease and PFS at 12 months were 71.37%. Conclusions In this study, the dose-reduced intravenous busulfan, cyclophosphamide and etoposide （BCV） conditioning was demonstrated an effective and safety regimen for ASCT-eligible patients with MM. However, the long term observation is needed.

关 键 词：多发性骨髓瘤 造血干细胞移植 移植预处理 

分 类 号：R733[医药卫生—肿瘤]