自体造血干细胞移植治疗初治多发性骨髓瘤的临床分析  

Autologous stem cell transplantation improve the survival of newly diagnosed multiple myeloma patients

作　　者：耿传营[1] 杨光忠[1] 王国蓉[1] 王慧娟[1] 周慧星[1] 张之尧 菅原[1] 陈文明[1] Geng Chuanying;Yang Guangzhong;Wang Guorong;Wang Huijuan;Zhou Huixing;Zhang Zhiyao;Jian Yuan;Chen Wenming(Department of Hematology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院血液科,北京100020

出　　处：《中华血液学杂志》2021年第5期390-395,共6页Chinese Journal of Hematology

摘　　要：目的评估自体造血干细胞移植(auto-HSCT)对初治多发性骨髓瘤(MM)疗效及生存的影响。方法回顾性分析2008年10月1日至2019年10月1日243例65岁以下接受auto-HSCT的初治MM患者,同时以同期176例≤65岁适合移植但未进行auto-HSCT的初治MM患者作为对照,评估auto-HSCT对患者疗效及生存的影响。为平衡auto-HSCT和非auto-HSCT患者之间各因素的分布,利用倾向性评分匹配技术按照1∶1比例匹配以减少组间的偏差。结果通过倾向性评分匹配分析,共筛选出128例患者(每组64例)。64例患者诱导治疗后接受auto-HSCT,24例(37.5%)获得严格意义的完全缓解(sCR),16例(25.0%)获得完全缓解(CR),15例(23.4%)获得非常好的部分缓解(VGPR),9例(14.1%)获得部分缓解(PR),auto-HSCT组疗效明显优于非auto-HSCT组(P=0.032)。与非auto-HSCT组相比,auto-HSCT组总生存(OS)和无进展生存(PFS)期明显延长[OS:87.6(95%CI 57.3~117.9)个月对53.9(95%CI 36.1~71.7)个月,P=0.011;PFS:42.2(95%CI 29.9~54.5)个月对22.4(95%CI 17.1~27.7)个月,P=0.007]。多因素分析显示auto-HSCT是OS(HR=0.448,95%CI 0.260~0.771,P=0.004)和PFS(HR=0.446,95%CI 0.280~0.778,P=0.003)的独立保护因素。结论auto-HSCT可改善适合移植初治MM患者的OS和PFS。Objective To evaluate the effect of autologous stem cell transplantation(auto-HSCT)on treatment remission and survival of newly diagnosed multiple myeloma(MM)patients.Methods A total of 243 new diagnosed MM patients(age≤65 years)who had received auto-HSCT were selected,and 176 MM patients(age≤65 years)who had not received auto-HSCT were selected as the control group to evaluate the effect of auto-HSCT on the remission and survival.To balance the distribution of prognostic factors between auto-HSCT and non-auto-HSCT patients,the propensity score matching technique was used to reduce the bias between groups in a 1∶1 scale,64 in each group,and correlation analysis was performed.Results A total of 128 patients(64 cases in each group)were screened by propensity score matching analysis.64 patients received auto-HSCT after induction therapy.After auto-HSCT,24 patients(37.5%)obtained sCR,16 patients(25.0%)obtained CR,15 patients(23.4%)obtained VGPR,and 9 patients(14.1%)obtained PR.The efficacy of patients with auto-HSCT was significantly better than that of non-auto-HSCT patients(P=0.032).Progression-free survival(PFS)and overall survival(OS)were significantly longer in auto-HSCT patients compared with non-auto-HSCT patients[PFS:42.2(95%CI 29.9-54.5)months vs 22.4(95%CI 17.1-27.7)months,P=0.007;OS:87.6(95%CI 57.3-117.9)months vs 53.9(95%CI 36.1-71.7)months,P=0.011].Multivariate analysis confirmed that auto-HSCT had a favorable effect on OS(HR=0.448,95%CI 0.260-0.771,P=0.004)and PFS(HR=0.446,95%CI 0.280-0.778,P=0.003).Conclusion These results demonstrated that auto-HSCT was a favorable prognostic factor for newly diagnosed MM patients.

关 键 词：多发性骨髓瘤 自体造血干细胞移植 生存 预后因素 

分 类 号：R733.3[医药卫生—肿瘤]