硼替佐米序贯自体造血干细胞移植治疗多发性骨髓瘤的临床研究  

VD,VTD therapy as induction treatment prior to autologous stem cell transplantation for multiple myeloma

作　　者：徐淑芬[1] 白海[1] 王存邦[1] 葸瑞[1] 潘耀柱[1] 张茜[1] 陈燕[1] 吴涛[1] 

机构地区：[1]兰州军区兰州总医院血液科,甘肃兰州730050

出　　处：《临床军医杂志》2015年第9期899-902,共4页Clinical Journal of Medical Officers

摘　　要：目的：探讨硼替佐米（ bortezomib）应用于多发性骨髓瘤（ MM）患者化疗缓解或部分缓解后行自体外周血造血干细胞移植（ APBSCT）的可行性和疗效。方法8例患者根据年龄及全身状态选择采用硼替佐米联合地塞米松（ VD）或硼替佐米联合吡喃阿霉素和地塞米松（VTD）方案进行移植前化疗。疗程第1、4、8、11天给予硼替佐米1.3 mg/m2静脉注射。 VD或VTD方案化疗4～6个疗程后,达到完全缓解（ CR）、非常好的部分缓解（ VGPR）或部分缓解（ PR）,随后行APBSCT,采用粒细胞集落刺激因子（ G-CSF）动员。预处理方案为硼替佐米＋马法兰。移植后以硼替佐米＋沙利度胺维持。结果所有患者在移植前均达到CR、VGPR或PR,干细胞采集充分,安全有效,移植后造血功能均快速顺利重建。移植后采用硼替佐米＋沙利度胺维持,随访8～68个月,死亡2例,其余患者均无病生存。结论 VD或VTD用于MM患者的治疗达VGPR、CR或PR后,进行APBSCT可行,为MM提供了一种新的治疗方案。移植后给予硼替佐米＋沙利度胺维持治疗可延长患者无病生存时间。Objective To evaluate the therapeutic efficacy and toxicity of VD or VAD therapy as induction treatment prior to autolo-gous peripheral stem cell transplantation（ APBSCT） for multiple myeloma（ MM） . Methods Totally 8 patients with MM received Bort-ezomib based therapy（VD,VTD）,intravenous injection of 1. 3 mg/m2 Bortezomib was performed on the 1st,4th,8th and 11th days of each course. Patients were managed with 4 to 6 courses. After complete remission,very good partial remission or partial remission,8 pa-tients underwent APBSCT. G-CSF was used for mobilization regimen,preparative regimen was Bortezomib ＋ melphalan,after-APBSCT maintenance was Bortezomib ＋ thalidomide. Results Induction pre-transplantation treatment with VD or VTD could increase the CR＋VGPR＋PR rate before APBSCT. All 8 patients in which a successful mobilization of peripheral stem cells were obtained with G-CSF. The patients underwent APBSCT showing a rapid and complete post-transplant hematological recovery/hematopoiet. After APB-SCT maintenance with Bortezomib ＋ thalidomide improves the response rate. With a follow-up time of 8 to 68 months,2 patients were dead,other patients were disease-free survival. Conclusion Our experience suggests that the patients with MM after complete remis-sion,very good partial remission or partial remission underwent APBSCT,it is not only very effective for patients with MM,but also an effective therapy without negative impact on stem cell mobilization. It is a new strategy for MM that the patients have received VD＋VTD then proceed to APBSCT. Application of bortezomib ＋ thalidomide after transplantation was favorable to MM patients for survival prolongation.

关 键 词：多发性骨髓瘤 硼替佐米 自体外周血干细胞移植 

分 类 号：R733.3[医药卫生—肿瘤]