PAD与TAD方案治疗新诊断多发性骨髓瘤患者的疗效比较及预后分析  

Response and prognosis of patients with multiple myeloma induced by PAD/TAD

作　　者：曾添美[1] 何海燕[1] 石昊天[2] 奚昊[1] 杜鹃[1] 张春阳[1] 姜华[1] 傅卫军[1] 周帆[2] 侯健[1] 

机构地区：[1]第二军医大学长征医院血液内科全军骨髓瘤与淋巴瘤疾病中心,上海200003 [2]上海市闸北区中心医院血液科

出　　处：《中华医学杂志》2015年第10期731-735,共5页National Medical Journal of China

基　　金：国家自然科学基金（30731160619）

摘　　要：目的 评价PAD方案（硼替佐米＋表柔吡星＋地塞米松）和TAD方案（沙利度胺＋表柔吡星＋地塞米松）诱导治疗后多发性骨髓瘤患者的疗效及预后,并评估细胞遗传学分层及自体造血干细胞移植对PAD诱导治疗患者预后的影响.方法 前瞻性研究191例自2008年5月至2013年12月经第二军医大学长征医院血液科及上海市闸北区中心医院血液科确诊的多发性骨髓瘤患者,非随机进入PAD诱导治疗组（PAD组,132例）和TAD诱导治疗组（TAD组,59例）,诱导后根据患者意愿分别按自体外周造血干细胞移植或原诱导方案巩固治疗,分析两组的诱导后疗效及生存差异,并评估细胞遗传学分层及自体造血干细胞移植对PAD诱导治疗患者的预后影响.结果 PAD与TAD组诱导后的缓解率分别为84.4％ （108/128）和69.5％（41/59）,差异有统计学意义（P=0.011）;获得非常好的部分缓解（VGPR）以上疗效率分别为70.3％（90/128）和32.2％ （19/59）,差异有统计学意义（P＜0.001）;获得接近完全缓解/完全缓解（nCR/CR）率分别为68.0％（87/128）和25.4％（15/59）,差异有统计学意义（P ＜0.001）.PAD组与TAD组患者的中位无进展生存（PFS）期及总生存（OS）期差异尚无统计学意义（P =0.223、0.989）.接受PAD诱导治疗的132例患者的生存分析显示：荧光原位杂交（FISH）高危组患者的中位PFS和OS均短于FISH低危组（15.2比19.1个月,41.2个月比未到达）,且OS差异有统计学意义（P =0.098、0.017）.根据巩固方式进一步的亚组生存分析显示,在FISH高危组,诱导后接受造血干细胞移植巩固患者的中位PFS期显著长于诱导后继续原诱导方案巩固的患者（17.8比14.6个月,P=0.029）,而两组之间的总生存期暂差异无统计学意义（P=0.840）.在FISH低危组,诱导后接受造血干细胞移植巩固患者与接受原诱导方案巩固患者间中位PFS及OS期差异均无统计学意义（P =0.131、Objective To evaluate the impact of cytogenetic grouping and autologous stem cell transplantation on the prognosis of patients with multiple myeloma （MM） induced by PAD （velcade ＋ epirubicin ＋ dexamethasone） and TAD （thalidomide ＋ epirubicin ＋ dexamethasone）.Methods A total of 191 patients with a definite diagnosis of MM were enrolled from May 2008 to December 2013 into this prospective study.They were non-randomly induced by PAD （n =132） or TAD （n =59） plus autologous stem cell transplantation or chemotherapy.Response and survival rates were also analyzed between two groups.Results The overall response rates of PAD and TAD groups were 84.4％ （108/128） and 69.5％ （41/59） （P =0.011） respectively.The very good partial remission（VGPR） rates were 70.3％ （90/128） and 32.2％ （19/59） （P ＜ 0.001） and near complete remission/complete remission （nCR/CR） rates 68.0％ （87/128） and 25.4％ （15/59） respectively （P ＜ 0.001）.Both progression-free survival （PFS） and overall survival （OS） showed no significant inter-group difference （P =0.223,0.989）.The survival analysis of PAD group showed that FISH high-risk group had shorter PFS and OS than FISH low-risk group （15.2 vs 19.1 months for PFS,P-0.098; 41.2 months vs non-attaining for OS,P =0.017）.In FISH high-risk group,patients consolidated with autologous stem cell transplantation showed longer PFS than those with chemotherapy （17.8 vs 14.6 months,P =0.029） while the OS showed no difference（P--0.840）.In FISH low-risk group,no difference were observed in PFS and OS between patients with consolidation therapies alone （P =0.131,0.294）.Conclusions The response rates are higher in patients induced by PAD than by TAD.After PAD induction,cytogenetic grouping may further distinguish the prognosis of MM patients.For FISH high-risk patients,their PFS is prolonged by autologous stem cell transplantation.

关 键 词：多发性骨髓瘤 造血干细胞移植 预后 细胞遗传学 

分 类 号：R733.3[医药卫生—肿瘤]