自体造血干细胞移植治疗多发性骨髓瘤的疗效评价及影响因素:单中心真实世界研究  

Evaluation of clinical efficacy and prognostic factors in multiple myeloma patients treated with auto-HSCT:A single-center real-world study

作　　者：平措卓嘎 王剑利[1] 徐燕[1] 赵万红[1] 张鹏宇[1] 刘捷[1] 雷博[1] 何爱丽[1] PINGCUO Zhuoga;WANG Jianli;XU Yan;ZHAO Wanhong;ZHANG Pengyu;LIU Jie;LEI Bo;HE Aili(Department of Hematology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Rheumatology and Hematology,Tibet Autonomous Region People’s Hospital,Lhasa 850000,China)

机构地区：[1]西安交通大学第二附属医院血液科,陕西西安710004 [2]西藏自治区人民医院风湿血液科,西藏拉萨850000

出　　处：《西安交通大学学报（医学版）》2023年第3期452-459,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划项目(No.2018JM7151)。

摘　　要：目的评价自体造血干细胞移植(auto-HSCT)治疗多发性骨髓瘤(MM)患者的临床疗效并分析预后影响因素。方法回顾性分析我院2014至2021年初诊且适合移植的155例MM患者的临床资料,根据治疗方式分为auto-HSCT组和非auto-HSCT组,比较两组患者的临床疗效、总生存(OS)及无进展生存(PFS),并对auto-HSCT组进行预后影响因素分析。结果①auto-HSCT组患者51例,非auto-HSCT组患者104例;两组除年龄外,余基线特征比较均无统计学差异。②auto-HSCT组患者均获得造血重建,无移植相关死亡病例。③对auto-HSCT组患者进行移植前、后的疗效对比,发现移植后sCR/CR率明显提高(P=0.041),有效缓解率(≥VGPR)亦提高(P=0.05);比较auto-HSCT组和非auto-HSCT组患者的最佳疗效,auto-HSCT组的sCR/CR率和有效缓解率均明显提高(P=0.001)。④至随访截止,auto-HSCT组中位OS未达到,中位PFS 30.5个月,3年OS、PFS分别为87%和40.3%;非auto-HSCT组中位OS 61个月,中位PFS 21个月,3年OS、PFS分别为65.3%和33.1%。与非移植组相比,auto-HSCT组OS明显延长(P=0.004),PFS亦延长但无统计学差异(P=0.065)。⑤对auto-HSCT组进行预后影响因素分析,发现血小板(PLT)减少、血清校正钙升高是影响OS的独立危险因素;PLT减少、女性、移植前疾病状态在PR及以下是影响PFS的独立危险因素。结论auto-HSCT能提高MM患者的疾病缓解率,延长OS,并可能延长PFS。血清校正钙升高及PLT减少是影响自体移植MM患者OS的独立预后因素,PLT减少、女性与移植前疾病状态在PR及以下是影响PFS的独立预后因素。Objective To evaluate the clinical efficacy and prognostic factors in multiple myeloma(MM)patients treated with autologous hematopoietic stem cell transplantation(auto-HSCT).Methods The clinical data of 155 MM patients newly diagnosed and suitable for transplantation in our hospital from 2014 to 2021 were retrospectively analyzed.They were divided into auto-HSCT group and non-auto-HSCT group according to the treatment mode.The clinical efficacy,overall survival(OS)and progression-free survival(PFS)of the two groups were compared.Furthermore,the prognostic factors of auto-HSCT group were analyzed.Results①There were 51 patients in auto-HSCT group and 104 patients in non-auto-HSCT group.There was no statistical difference in baseline characteristics except age between the two groups.②Hematopoietic reconstruction was achieved in all patients in auto-HSCT group,and no transplantation-related mortality was found.③The clinical efficacy of pre-and post-transplantation was compared in auto-HSCT group.sCR/CR rate was significantly increased after transplantation(P=0.041).The effective remission rate(≥VGPR)was also higher(P=0.05).As for the best efficacy,sCR/CR rate and effective remission rate were both significantly higher in auto-HSCT group than in non-auto-HSCT group(P=0.001).④In auto-HSCT group,by the end of follow-up,the median OS was not reached,the median PFS was 30.5 months,and 3-year OS and PFS was 87% and 40.3%,respectively.In non-auto-HSCT group,the median OS was 61 months,the median PFS was 21 months,and 3-year OS and PFS was 65.3% and 33.1%,respectively.It indicated that OS was significantly prolonged in auto-HSCT group(P=0.004).PFS was also prolonged but without significant difference(P=0.065).⑤Analysis of prognostic factors in auto-HSCT group showed that decreased PLT(P=0.038)and increased serum-adjusted calcium(P=0.017)were independent risk factors for OS,decreased PLT(P=0.005),female(P=0.018)and disease status of PR or worse before transplantation(P=0.012)were independent risk factors for PFS.C

关 键 词：自体造血干细胞移植 多发性骨髓瘤 临床疗效 预后影响因素 

分 类 号：R733[医药卫生—肿瘤]