VRD与VCD方案诱导治疗后序贯自体造血干细胞移植对新诊断的多发性骨髓瘤患者的疗效分析  

VRD versus VCD induction chemotherapy followed by autologous stem cell transplantation in newly diagnosed multiple myeloma

作　　者：王慧娟[1] 杨光忠[1] 菅原[1] 耿传营[1] 周慧星[1] 陈文明[1] Wang Huijuan;Yang Guangzhong;Jian Yuan;Geng Chuanying;Zhou Huixing;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：《首都医科大学学报》2021年第4期615-622,共8页Journal of Capital Medical University

基　　金：科技部“重大新药创制”科技重大专项(2018ZX09733003)。

摘　　要：目的评价硼替佐米+来那度胺+地塞米松(bortezomib-lenalidomide-dexamethasone,VRD)与硼替佐米+环磷酰胺+地塞米松(bortezomib-cyclophosphamide-dexamethasone,VCD)两种诱导治疗方案对接受自体造血干细胞移植(autologous stem cell transplantation,ASCT)的多发性骨髓瘤(multiple myeloma,MM)患者的疗效、干细胞采集和预后的影响。方法回顾性分析首都医科大学附属北京朝阳医院自2010年10月至2019年10月间接受VRD(39例)或VCD(71例)方案诱导治疗后序贯自体外周血干细胞移植、长期随访并且资料完整的110例MM患者的临床数据。对采用两种方案的两组患者进行疗效评估和生存分析。并分析对细胞采集的影响。结果两组患者移植后,缓解深度和二代流式法所测得的微小残留病(minimal residual disease,MRD)阴性率均得到了提高。与移植前相比,VCD组移植后3个月的完全缓解(complete response,CR)/严格意义完全缓解(stringent complete response,sCR)率从39.4%提升至59.1%(P=0.001),MRD阴性率从16.7%提高至41.7%(P=0.003)。而VRD组的CR/sCR率从51.2%提升至67.6%(P=0.008),MRD阴性率也由26.1%提高至47.8%(P=0.059)。具有高危细胞遗传学[t(4;14),t(14;16)和del(17p)]的患者也可达到相似的疗效。在生存时间方面,VCD组的中位无进展生存期(progression-free survival,PFS)与总体生存期(overall survival,OS)分别为72.0个月与98.0个月,而VRD组的中位PFS及OS均尚未达到(PFS:P=0.856;OS:P=0.382)。VRD组采集CD34^(+)细胞数显著低于VCD组(3.52×10^(6)/kg vs 4.65×10^(6)/kg,P=0.046),但两组间动员失败患者数差异无统计学意义。VRD方案诱导治疗超过4个疗程后,采集的CD34^(+)细胞数即有下降趋势,而VCD方案诱导治疗3~6个疗程对CD34^(+)细胞数无明显影响。结论与VCD方案相比,VRD方案诱导治疗能够达到更深层次的缓解,但对生存并无显著影响。VRD方案的诱导治疗疗程数对干细胞的采集数量有一定影响,其采集干细胞前疗Objective To evaluate the effects of bortezomib-lenalidomide-dexamethasone(VRD)and bortezomib-cyclophosphamide-dexamethasone(VCD)induction chemotherapy on the response,stem cell collection and prognosis in multiple myeloma(MM)patients undergoing autologous stem cell transplantation(ASCT).Methods We retrospective analyzed clinical data from 110 newly diagnosed multiple myeloma(NDMM)patients who received autologous stem cell transplantation after VRD or VCD induction chemotherapy with available complete follow-up data between October 2010 and October 2019 in Beijing Chaoyang Hospital.Results The depth of response and minimal residual disease(MRD)-negative rate were improved in both groups after ASCT.At the 3 rd month after ASCT,the complete response(CR)/stringent complete response(sCR)rate in VCD group improved from 39.4%to 59.1%(P=0.001),and the MRD-negative rate improved from 16.7%to 41.7%(P=0.003).While the CR/sCR rate in VRD group improved from 51.2%to 67.6%(P=0.008),and the MRD-negative rate detected by next generation flow cytometry improved from 26.1%to 47.8%(P=0.059).Those who carried high-risk cytogenetics(t(4;14),t(14;16)and del(17 p))had similar response rates.As to survival analysis,the median progression-free survival(PFS)and overall survival(OS)in VCD group were 72.0 and 98.0 months,respectively,while neither had been reached in the VRD group(PFS:P=0.856;OS:P=0.382).The median number of CD34-positive cells was lower in VRD group than that in VCD group(3.52×10^(6)/kg vs 4.65×10^(6)/kg,P=0.046),while collection failure rates in the two groups did not show statistically significant difference.The number of CD34-positive cells tended to decrease after more than 4 courses of VRD induction therapies,while it remained stable between 3 to 6 courses of VCD induction therapies.Conclusion VRD induction chemotherapy could achieve deeper response than VCD,without significant effect on survival prognosis.VRD induction regimen could result in less stem cells harvested,thus the courses before stem cell collection s

关 键 词：多发性骨髓瘤 自体造血干细胞移植 诱导治疗 微小残留病 干细胞采集 

分 类 号：R733.3[医药卫生—肿瘤]