硼替佐米联合沙利度胺和地塞米松方案序贯造血干细胞移植治疗初治多发性骨髓瘤的临床观察  

Bortezomib-based chemotherapy plus hematopoietic stem cell transplantation for patients with multiple myeloma:a single center experience

作　　者：薛燕[1] 李晓林[1] 付杰[1] 王洋[1] 张慈现[1] 杨扬[1] 蒙延娜 

机构地区：[1]江苏省徐州市中心医院血液科,徐州221009

出　　处：《中国肿瘤临床与康复》2014年第10期1184-1188,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨硼替佐米联合方案序贯造血干细胞移植治疗初治多发性骨髓瘤的疗效和相关毒副作用。方法选取2006年6月至2014年4月初治多发性骨髓瘤33例为研究对象,采用硼替佐米＋沙利度胺＋地塞米松（BTD）方案诱导治疗（2~7个疗程）,其中14例继以马法兰预处理后行造血干细胞移植;所有患者均接受沙利度胺＋地塞米松（TD）或来那度胺＋地塞米松（LD）方案维持治疗。随访5~92个月,观察疗效及不良反应。结果 BTD方案诱导治疗后获得完全缓解（CR）、很好的部分缓解（VGPR）、部分缓解（PR）的例数分别为8例（24.2%）、11例（33.3%）、12例（36.4%）,总有效率（ORR）为94.0%。14例移植患者中,移植后获VGPR 9例,单用BTD组和序贯移植组的中位随访时间分别为51和32个月,中位生存时间尚未获得,预期3年无进展生存率分别为42.3%和58.7%。BTD方案的不良反应主要为血细胞减少、周围神经病变、带状疱疹病毒感染、便秘、感染和乏力等,大多数患者给予对症治疗后可耐受。结论以硼替佐米联合诱导治疗并以造血干细胞移植序贯治疗多发性骨髓瘤,毒副反应可耐受,疗效显著,生存期较长。Objective To observe the efficacy and toxicity of Bortezomib-based chemotherapy plus hematopoietic stem cell transplantation for patients with multiple myeloma（ MM）.Methods A total of 33 patients with newly diagnosed multiple myeloma was enrolled in the study from June 2006 to April 2014.All patients were given regular treatment of bortezomibthalidomidedexamethasone（ BTD） regime 2 to7 cycles for induction therapy.Then,14 of the 33 patients received autologous stem cell transplantation（ HSCT） after the pretreatment of oral melphalan.All patients had received TD（ thalidomide ＋ dexamethasone） or LD（ lenalidomide ＋ dexamethasone） regimin for maintenance therapy.Follow up lasted for 5 ~92 mo to observe the efficacy and adverse reactions.Results The overall response（ OR） of patients after BTD regime treatment was 94.0%,including a complete response（ CR） of 24.2%（ 8 /33）,very good partial response（ VGPR） of 33.3%（ 11/33）,and partial response of 36.4%（ 12/33）.14 patients after hematopoietic stem cell transplantation,9 patients achieved VGPR or CR.Median follow-up time of patients with HSCT and without HSCT were 32 and 51 mo,respectively.The median survival time have not acquired.3-yr expected progression-free survival with HSCT and without HSCT were 58.7%,42.3%,respectively.The main BTD regimen-associated toxicities regime mostly included hemocytopenia,peripheral neuropathy,herpes zoster virus infection,constipation,infection,fatigue and so on.Most of patients could tolerate after symptomatic treatment.Conclusion Bortezomib-based chemotherapy plus hematopoietic stem cell transplantation is an effective therapy for newly diagnosed multiple myeloma patients,could prolong survival time and the adverse reactions of BTD regime are tolerable.

关 键 词：靶向治疗 造血干细胞移植 硼替佐米 多发性骨髓瘤 沙利度胺 

分 类 号：R733.3[医药卫生—肿瘤]