自体造血干细胞移植对多发性骨髓瘤患者微小残留病的影响  

Effect of autologous hematopoietic stem cell transplantation on minimal residual disease in patients with multiple myeloma

作　　者：沈莉菁[1] 颛孙诗雅 倪蓓文[1] 张旻玥[1] 路莎莎[1] 华燕妮 肖丹 黄洪晖[1] 韩晓凤[1] 钟璐[1] 钟华[1] 王婷[1] 侯健 Shen Lijing;Zhuansun Shiya;Ni Beiwen;Zhang Minyue;Lu Shasha;Hua Yanni;Xiao Dan;Huang Honghui;Han Xiaofeng;Zhong Lu;Zhong Hua;Wang Ting;Hou Jian(Department of Hematology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血液科,上海200127

出　　处：《中华医学杂志》2022年第36期2861-2867,共7页National Medical Journal of China

摘　　要：目的评价自体造血干细胞移植(ASCT)对多发性骨髓瘤(MM)患者微小残留病(MRD)的影响。方法分析2018年8月至2021年8月在上海交通大学医学院附属仁济医院接受硼替佐米+环磷酰胺+地塞米松(VCD)或硼替佐米+来那度胺+地塞米松(VRD)方案诱导,序贯ASCT治疗的92例初治MM患者的完全缓解(CR)率和MRD阴性率。评估不同临床特征、诱导方案、移植前疗效和移植预处理方案对于移植后第100天疗效及预后的影响。结果92例患者中,男45例,女47例,中位年龄57.3(35~67)岁,接受VCD和VRD方案诱导的患者分别为57例和35例,接受白消安+环磷酰胺+依托泊甙(BCV)或高剂量马法兰(HDM)方案移植预处理的患者分别为43例和49例。92例患者移植后总CR率由23.9%(22/92)提升至移植后的58.7%(54/92),MRD阴性率由4.4%(4/92)提升至33.7%(31/92),差异均有统计学意义(均P<0.05)。移植前获得部分缓解(PR)、非常好的部分缓解(VGPR)及≥CR疗效的三组患者,移植后MRD阴性率分别为17.6%(6/34)、33.3%(12/36)和59.1%(13/22)(P=0.006)。初诊时伴或不伴浆细胞瘤的患者,移植后的CR率分别为36.4%(4/11)和65.4%(53/81)(P=0.029),MRD阴性率分别为18.2%(2/11)和39.5%(32/81)(P=0.037),差异均有统计学意义。高危细胞遗传学异常的患者与标危组移植后MRD阴性率分别为30.5%(12/28)和42.9%(18/59)(P=0.258)。移植前达到≥VGPR疗效的患者,移植后的MRD阴性率在VCD诱导组和VRD组分别为29%(9/31)和59.3%(16/27)(P=0.033),BCV预处理组和HDM组分别为24%(6/25)和57.6%(19/33)(P=0.016),差异均有统计学意义。结论ASCT能克服高危细胞遗传学异常等不良因素,显著提升MM患者的CR率和MRD阴性率,但初诊时伴浆细胞瘤的患者获益不如无浆细胞瘤的患者。Objective To evaluate the effect of autologous hematopoietic stem cell transplantation(ASCT)on minimal residual disease(MRD)in patients with multiple myeloma(MM).Method From August 2018 to August 2021,92 patients newly diagnosed with MM who had received either the bortezomib combined with cyclophosphamide and dexamethasone(VCD)or the bortezomib,lenalidomide and dexamethasone(VRD)induction regimens followed by sequential ASCT were assessed for overall survival(OS)and the MRD negative rate.The differences in efficacy at 100 days after transplantation were assessed according to factors,including age,risk stratification,target organ damage,and pre-transplant regimen,etc.Results Among the 92 patients,there were 45 males and 47 females,with a median age of 57.3(35-67)years.Fifty-seven patients received the VCD regimen,and 35 received VRD as induction regimen.Forty-three patients received busulphan combined with cyclophosphamide and etoposide(BCV),and 49 patients received high-dose melphan(HDM)regimen as pre-transplantation treatment.After transplantation,the total complete remission(CR)rate of 92 patients increased from 23.9%(22/92)to 58.7%(54/92),and the MRD negative rate increased from 4.4%(4/92)to 33.7%(31/92),and the differences were statistically significant(all P<0.05).After transplantation,the MRD negative rates of patients with PR,VGPR and≥CR before transplantation were 17.6%(6/34),33.3%(12/36)and 59.1%(13/22),respectively(P=0.006).The CR rates of patients with or without plasmacytoma at initial diagnosis were 36.4%(4/11)and 65.4%(53/81),respectively(P=0.029),and the MRD negative rates were 18.2%(2/11)and 39.5%(32/81),respectively(P=0.037),and the differences were statistically significant.The MRD negative rates in high-risk patients and standard-risk group were 30.5%(12/28)and 42.9%(18/59),respectively(P=0.258).For patients who achieved efficacy above VGPR before transplantation,the MRD negative rates after transplantation in VCD-induced group and VRD group were 29%(9/31)and 59.3%(16/27),respectively(P=0.033

关 键 词：多发性骨髓瘤 自体造血干细胞移植 微小残留病 马法兰 浆细胞瘤 回顾性队列研究 

分 类 号：R733.3[医药卫生—肿瘤]