异常蛋白条带在含硼替佐米方案诱导序贯自体造血干细胞移植治疗多发性骨髓瘤患者中的意义  

Clinical significance of abnormal protein bands in multiple myeloma treated with bortezomib-based induction regimen and autologous stem cell transplantation

作　　者：王荷花[1] 李娟[1] 刘俊茹[1] 郑冬[1] 谷景立[1] 颜绵生[1] 邹外一[1] 许多荣[1] 

机构地区：[1]中山大学附属第一医院血液科,广州510080

出　　处：《中华血液学杂志》2013年第4期327-331,共5页Chinese Journal of Hematology

摘　　要：目的研究接受含硼替佐米方案诱导序贯自体造血干细胞移植（ASCT）治疗多发性骨髓瘤（MM）患者出现异常蛋白条带（APB）的临床意义。方法回顾性分析2007年1月至2012年7月接受含硼替佐米方案诱导序贯ASCT治疗68例MM患者的资料，采用免疫固定电泳方法检测M蛋白。结果33例（48．5％）MM患者出现APB，2例轻链型在诱导化疗达完全缓解（CR）后移植前首次出现APB，31例患者在移植后中位时间104（33—404）d首次出现APB，APB出现例次中位数为2（1—7）次，持续中位时间为105（35～801）d。33例出现APB组患者移植后疗效显著高于35例未出现APB（Non—APB）组患者，CR＋非常好的部分缓解（VGPR）率分别为100．O％和85．7％（P=0．017），CR率分别为87．9％和62．9％，差异有统计学意义（P=0．03）。两组患者在性别、年龄、HGB、ALB、13：微球蛋白水平、MM类型、D—S分期、ISS分期、硼替佐米一线或二／三线治疗例数、含硼替佐米化疗疗程数及自体造血干细胞移植方式上差异均无统计学意义（P〉0．05）。中位随访33．4（7．0～71．7）个月，与Non—APB组比较APB组患者OS更长，目前差异尚未显示统计学意义（P〉0．05）。17例首次出现APB时间在移植后≥6个月与14例移植后〈6个月内患者比较总生存期更长，目前尚未显示统计学差异（P〉0．05）。结论接受含硼替佐米方案诱导序贯ASCT治疗的MM患者出现APB者疗效更高、预后更好。Objective To study the clinical significance of abnormal protein bands （APB） in multi- ple myeloma （MM） patients treated with bortezomib-based induction regimen and autologous stem cell transplantation （ASCT）. Methods Sixty-eight MM patients submitted to bortezomib-based induction therapy and ASCT from January 2007 to July 2012 were retrospectively studied. Monoclonal protein was detected by immu- nofixation electrophoresis （IFE）. Results Of all 68 patients, 33 （48.5%） patients had APB. At the first emergence of an APB, two patients with light chain type achieved CR and before transplantation, and thirtyone patients were after transplantation with median time of 104（ ranged 33 -404）days. The median duration of APB appearance was 105 （ranged 35 -801 ）days. Patients who developed APB compared with those without APB, had a significantly higher CR plus very good partial response （VGPR） rates （ 100.0% vs. 85.7% %, P =0. 017） and CR rates （87.9% vs. 62.9% ） （P =0.03）. There were no significant differences in gender, age, HGB, ALB, β2-microglobulin, M protein type, Durie-Salmon and ISS stages, the case number of first line or second line treatment, induction courses of bortezomib-based regimen, and the mode of ASCT. With a median follow-up of 33.4 （ ranged 7.0 - 71.7 ） months, patients with APB tended to have a longer overall survival （OS） versus non-APB patients, although no significant difference obtained （P 〉 0.05 ）. Amon APB oatients. OS was longer in oatients whose aot3earance of APB occurred 〈 6 months aftertransplantation than those 〉i 6 months, but the significant difference was not obtained yet （ P 〉 0.05 ）. Conclusions Patients who developed APB had a significantly better response to bortezomib-based induction regimen followed ASCT. APB emergence has a good prognostic significance.

关 键 词：硼替佐米 多发性骨髓瘤 造血干细胞移植 异常蛋白条带 M蛋白 

分 类 号：R733.3[医药卫生—肿瘤]