VRD方案序贯自体造血干细胞移植治疗新诊断多发性骨髓瘤患者的疗效和安全性研究  

Efficacy and safety of VRD regimen of autologous hematopoietic stem cell transplantation in patients with newly diagnosed multiple myeloma

作　　者：颜霜[1] 金松[1] 王攀峰 颜灵芝[1] 商京晶[1] 施晓兰[1] 吴小津[1] 翟英颖 姚卫芹 王婧 姚颖 傅琤琤[1] Yan Shuang;Jin Song;Wang Panfeng;Yan Lingzhi;Shang Jingjing;Shi Xiaolan;Wu Xiaojin;Zhai Yingying;Yao Weiqin;Wang Jing;Yao Ying;Fu Chengcheng(Department of Hematology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Hematology,Soochow Hopes Hematology Hospital,Suzhou 215128,China)

机构地区：[1]苏州大学附属第一医院血液科,苏州215006 [2]苏州弘慈血液病医院血液科,苏州215128

出　　处：《中华内科杂志》2023年第7期819-825,共7页Chinese Journal of Internal Medicine

摘　　要：目的探讨70岁及以下初诊多发性骨髓瘤(MM)患者接受VRD方案(硼替佐米、来那度胺联合地塞米松)诱导治疗后自体造血干细胞采集率和行序贯自体造血干细胞移植术的疗效及安全性。方法回顾性病例系列研究。收集2018年8月1日至2020年6月30日在苏州大学附属第一医院和苏州弘慈血液病医院诊治的123例适合行VRD方案序贯自体造血干细胞移植的初诊MM患者的临床资料, 回顾性分析其临床特征、诱导治疗后效果、动员自体干细胞方案、自体造血干细胞采集率, 以及自体造血干细胞移植的副作用和疗效。结果 123例患者中男性67例, 中位年龄为56岁(范围31~70岁), IgG、IgA、IgD、轻链型分别占47.2%(58例)、23.6%(29例)、3.2%(4例)、26.0%(32例);肾功能不全(肌酐清除率<40 ml/min)占25.2%(31例);修订的国际分期体系(R-ISS分期)Ⅲ期者占18.2%(22/121)。123例患者经过诱导治疗后部分缓解及以上率为82.1%(101例), 非常好的部分缓解(VGPR)及以上率为75.6%(93例), 完全缓解+严格意义的完全缓解率为45.5%(56例)。90.3%(84/93)患者行环磷酰胺+粒细胞集落刺激因子(G-CSF)动员, 8例患者因肌酐清除率<30 ml/min行G-CSF单药动员方案或G-CSF+普乐沙福方案动员, 1例患者因疾病进展行DECP(顺铂+依托泊苷+环磷酰胺+地塞米松)+G-CSF方案动员。自体干细胞采集CD34+细胞数≥2×106/kg体重的比例为89.1%(82/92), 细胞数≥5×106/kg体重的比例为56.5%(52/92)。77例行VRD方案序贯自体造血干细胞移植患者的中性粒细胞减少及血小板计数减少不良反应均达到4级。非血液学不良反应发生率由高到低分别为消化道反应(76.6%, 59/77)、口腔黏膜炎(46.8%, 36/77)、转氨酶升高(44.2%, 34/77)、发热(37.7%, 29/77)、感染(16.9%, 13/77)、心脏相关不良反应(11.7%, 9/77);其中3级不良反应有恶心(6.5%, 5/77)、口腔黏膜炎(5.2%, 4/77)、呕吐(3.9%, 3/77)、感染(2.6%, 2/77)、输注后血压升高(Objective To explore the stem cell collection rate and efficacy and safety of patients aged 70 and below with newly diagnosed multiple myeloma(MM)treated with the VRD(bortezomib,lenalidomide and dexamethasone)regimen followed by autologous stem cell transplantation(ASCT).Methods Retrospective case series study.The clinical data of 123 patients with newly diagnosed MM from August 1,2018,to June 30,2020,at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematology Hospital,who were eligible for VRD regimen sequential ASCT,were collected.The clinical characteristics,efficacy after induction therapy,mobilization regimen of autologous stem cells,autologous stem cell collection rate,and side effects and efficacy of ASCT were retrospectively analyzed.Results Of the 123 patients,67 were males.The median patient age was 56(range:31-70)years.Patients with IgG,IgA,IgD,and light-chain types accounted for 47.2%(58/123),23.6%(29/123),3.2%(4/123),and 26.0%(32/123)of patients,respectively.In addition,25.2%(31/123)of patients had renal insufficiency(creatinine clearance rate<40 ml/min).Patients with Revised-International Staging System(R-ISS)Ⅲaccounted for 18.2%(22/121)of patients.After induction therapy,the rates of partial response and above,very-good partial response(VGPR)and above,and complete response(CR)+stringent CR were 82.1%(101/123),75.6%(93/123),and 45.5%(56/123),respectively.Overall,90.3%(84/93)of patients were mobilized with cyclophosphamide+granulocyte colony-stimulating factor(G-CSF)and 8 patients with G-CSF or G-CSF+plerixafor due to creatinine clearance rate<30 ml/min and one of them was mobilized with DECP(cisplatin,etoposide,cyclophosphamide and dexamethasone)+G-CSF for progressive disease.The rate of autologous stem cell collection(CD34+cells≥2×106/kg)after four courses of VRD regimen was 89.1%(82/92),and the rate of collection(CD34+cells≥5×106/kg)was 56.5%(52/92).Seventy-seven patients treated with the VRD regimen sequential ASCT.All patients had grade 4 neutropenia and thrombocyt

关 键 词：多发性骨髓瘤 造血干细胞移植 移植 自体 硼替佐米 来那度胺 

分 类 号：R733.3[医药卫生—肿瘤]