自体造血干细胞移植治疗多发性骨髓瘤的疗效及预后影响因素分析  

Efficacy and prognostic factors of autologous hematopoietic stem cell transplantation in multiple myeloma

作　　者：杨菲燕 王晴晴 千晨静 何静[1] ANG Feiyan;WANG Qingqing;QIAN Chenjing;HE Jing(Department of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血液科,湖北武汉430022

出　　处：《现代肿瘤医学》2021年第7期1210-1215,共6页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81974003)。

摘　　要：目的:探讨自体造血干细胞移植治疗多发性骨髓瘤(MM)的疗效和影响MM患者预后的因素。方法:回顾性分析我院2012年01月至2019年12月37例接受自体造血干细胞移植的MM患者的临床资料,中位随访时间为55(1~91)个月。对37例患者的反应深度、无进展生存时间(PFS)、总生存时间(OS)和影响预后的相关因素进行分析。结果:移植后3月内疗效达到完全缓解率和深度缓解率均优于移植前(P<0.01,P<0.05),移植前后总有效率(ORR)比较无统计学意义(P>0.05)。患者3年、5年OS率为97.0%、81.4%;3年、5年PFS率为62.7%、51.0%;中位PFS和OS均未获得。单因素分析结果表明移植后3月内疗效获得深度缓解较未获得患者无论是OS还是PFS均较优(P均<0.01);诱导化疗后获得深度缓解可明显延长OS(P<0.05);DS分期Ⅰ-Ⅱ期、mSMART3.0危险分层标危患者相比DS分期Ⅲ期、高危患者PFS均有明显优势(P<0.05)。Cox多因素回归分析显示,移植后3月内疗效达深度缓解是PFS和OS的独立预后因素,mSMART3.0危险分层也是PFS的独立预后因素。结论:自体造血干细胞移植可以提高MM患者的反应深度。移植前后疗效、DS分期和mSMART3.0危险分层均可影响MM患者生存率。移植后3月内疗效达深度缓解是PFS和OS的独立预后因素,mSMART3.0危险分层也是PFS的独立预后因素。Objective:To investigate the efficacy of autologous hematopoietic stem cell transplantation(ASCT)in the treatment of multiple myeloma(MM)and the factors affecting the prognosis of MM patients.Methods:The clinical data of 37 MM patients who underwent ASCT from January 2012 to December 2019 in our hospital were retrospectively analyzed.The median follow-up time was 55(1~91)months.The depth of response,progression free survival(PFS),overall survival(OS)and related prognostic factors of 37 patients were analyzed.Results:The complete remission rate and deep remission rate within 3 months after transplantation were superior to those before transplantation(P<0.01,P<0.05).There was no significant difference in the overall response rate(ORR)between the two groups(P>0.05).The 3-year and 5-year OS rates were 97.0%and 81.4%.The 3-year and 5-year PFS rates were 62.7%and 51.0%,and the median PFS and OS were not reached.Univariate analysis showed that patients with deep response within 3 months after transplantation had better OS and PFS than those without deep response(P<0.01).Patients with deep response after induction chemotherapy could significantly prolong OS(P<0.05).DS stage I-II and mSMART3.0 risk stratification standardrisk stratification patients had significant advantages in PFS compared with DS stage III and high risk stratification patients(P<0.05).Cox multivariate regression analysis showed that deep response within 3 months after transplantation was an independent prognostic factor for PFS and OS,and mSMART3.0 risk stratification was also an independent prognostic factor for PFS.Conclusion:ASCT can improve the depth of response in MM patients.Achieving deep remission in response before and after transplantation,DS stageand mSMART3.0 risk stratification can affect MM patient survival.Deep response within 3 months after transplantation was an independent prognostic factor for PFS and OS,and mSMART3.0 risk stratification was also an independent prognostic factor for PFS.

关 键 词：自体造血干细胞移植 多发性骨髓瘤 生存期 预后因素 

分 类 号：R733.3[医药卫生—肿瘤]