含新药诱导化疗序贯自体造血干细胞移植、维持治疗策略治疗多发性骨髓瘤300例——单中心回顾性研究  

New agents-based induction chemotherapy followed by autologous stem cell transplantation and maintenance treatment strategy for multiple myeloma:a single center retrospective study of 300 cases

作　　者：刘俊茹[1] 谷景立[1] 黄蓓晖[1] 邝丽芬 陈美兰[1] 邹外一[1] 郑冬[1] 王荷花[1] 许多荣[1] 李娟[1] Liu Junru;Gu Jingli;Huang Beihui;Kuang Lifen;Chen Meilan;Zou Waiyi;Zheng Dong;Wang Hehua;Xu Duorong;Li Juan(Department of Hematology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510080,China)

机构地区：[1]中山大学附属第一医院,广州510080

出　　处：《中华血液学杂志》2022年第12期1003-1009,共7页Chinese Journal of Hematology

基　　金：广东省自然科学基金(2018A030313651);中山大学临床医学研究5010计划项目(2017005)。

摘　　要：目的分析含新药诱导化疗序贯自体造血干细胞移植(auto-HSCT)、维持治疗策略治疗多发性骨髓瘤(MM)患者的预后及影响因素。方法对近15年接受含新药方案诱导化疗序贯auto-HSCT、维持治疗的300例MM患者进行回顾性分析。结果诱导化疗、auto-HSCT、维持治疗后的完全缓解(CR)率分别为35.3%、55.2%、72.4%,≥非常好的部分缓解(VGPR)率分别为80.0%、89.2%、93.4%;PAD方案(硼替佐米+脂质体阿霉素+地塞米松)诱导化疗的≥VGPR率、总反应率(ORR)均高于VD方案(硼替佐米+地塞米松),PAD方案和RAD方案(来那度胺+脂质体阿霉素+地塞米松)相比,CR率、≥VGPR率以及ORR差异均无统计学意义;诱导化疗、auto-HSCT、维持治疗后流式细胞术微小残留病(MRD)阴性患者在CR患者中的占比分别为18.8%(54例)、41.4%(109例)、58.7%(142例)。中位随访时间48.5(7.4~171.3)个月,全部MM患者中位疾病进展时间(TTP)为78.7个月,中位总生存(OS)时间为109.0个月;R-ISSⅠ、Ⅱ、Ⅲ期患者的中位TTP时间分别为111.8、77.4、30.6个月,中位OS时间分别为118.8、91.4、48.5个月。在治疗的不同阶段获得CR和MRD阴性患者的TTP、OS时间均较未获得CR和MRD阴性患者明显延长。在诱导化疗阶段获得CR的伴有高危细胞遗传学患者,其TTP短于不伴高危细胞遗传学患者;诱导化疗阶段获得MRD阴性的高危细胞遗传学患者,其TTP和不伴高危细胞遗传学患者相比差异无统计学意义。多因素分析显示,R-ISS分期在不同治疗阶段都是影响TTP和OS的不良预后因素;患者在接受治疗后,治疗获得的疗效就成为新的独立不良预后因素。结论含新药诱导化疗序贯auto-HSCT、维持治疗的MM整体治疗策略具有较好的远期疗效,但高危MM患者获益不明显。Objective To examine the survival and influential factors of an integrated approach of novel agents,autologous hematopoietic stem cell(auto-HSCT),and maintenance therapy in patients with multiple myeloma(MM)patients from a single center over the past 15 years.Methods In our center,300 MM patients who received an integrated strategy of new agents,auto-HSCT,and maintenance therapy over 15 years were retrospectively and prospectively analyzed.Results The complete remission rates(CR)and≥very good partial remission rates(VGPR)following induction therapy,transplantation,and maintenance therapy were respectively 35.3%and 55.2%,72.4%and 80.0%,89.2%,and 93.4%.When compared to patients receiving double-drug induction,the≥VGPR and ORR of patients receiving triple-drug induction were improved.No difference existed in CR,≥VGPR,and ORR between the PAD(bortezomib+liposome doxorubicin+dexamethasone)and RAD(lenalidomide+liposome doxorubicin+dexamethasone)regimens,but the benefits speed differed.The negative rate of flow minimal residual disease following induction,transplantation,and maintenance was 18.8%(54 cases),41.4%(109 cases),and 58.7%(142 cases),respectively.The median time to progress(TTP)was 78.7 months and the median overall survival(OS)was 109 months.The median TTP for RISS-Ⅰ-Ⅲpatients were 111.8 months,77.4 months,and 30.6 months,and the median OS was 118.8 months,91.4 months,and 48.5 months,respectively.At various points during treatment,the TTP and OS of patients obtaining CR and MRD negative were longer than those of patients who did not obtain CR and MRD negative.TTP was noticeably shorter in high-risk cytogenetic patients compared to standard-risk patients even when CR was acquired during induction.There was no difference in TTP between patients with high-risk cytogenetics and those with standard-risk cytogenetics if MRD negative was acquired during induction.According to a multivariate analysis,the R-ISS stage was a poor predictor of TTP and OS at various treatment intervals.Therapeutic effectiveness w

关 键 词：多发性骨髓瘤 自体造血干细胞移植 微小残留病 

分 类 号：R733.3[医药卫生—肿瘤]