自体造血干细胞移植治疗多发性骨髓瘤的效果及安全性  

Efficacy and safety of autologous hematopoietic stem cell transplantation in patients with multiple myeloma

作　　者：沈莹[1] 王芳侠[1] 雷博[1] 刘捷[1] 王剑利[1] 古流芳[1] 杨云[1] 张鹏宇[1] 马肖容[1] 赵万红[1] Shen Ying;Wang Fangxia;Lei Bo;Liu Jie;Wang Jianli;Gu Liufang;Yang Yun;Zhang Pengyu;Ma Xiaorong;Zhao Wanhong(Department of Hematology,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院血液内科,西安710004

出　　处：《白血病．淋巴瘤》2023年第12期717-722,共6页Journal of Leukemia & Lymphoma

基　　金：陕西省自然科学基金(2018SF-002、2020JQ-539)。

摘　　要：目的探讨自体造血干细胞移植(ASCT)治疗多发性骨髓瘤(MM)的效果及安全性。方法回顾性分析2015年10月至2022年3月西安交通大学第二附属医院接受ASCT的64例MM患者的临床资料,总结患者临床特点、治疗效果及相关不良反应。结果64例中,男性42例,女性22例,中位年龄54岁(37~69岁)。46例CE(环磷酰胺、依托泊苷)方案动员组及17例普乐沙福动员组采集CD34+细胞中位数分别为7.50×10^(6)/kg[(1.15~24.73)×10^(6)/kg]、4.54×10^(6)/kg[(0.75~10.40)×10^(6)/kg],差异有统计学意义(Z=3.02,P=0.024)。64例患者均造血重建成功,其中白细胞、血小板植活的中位时间分别为11 d(8~13 d)、11 d(8~15 d)。患者预处理方案均采用大剂量美法仑,其中29例口服组白细胞及血小板植活中位时间分别为11 d(8~13 d)、11 d(8~15 d),35例静脉输注组分别为11 d(8~12 d)、11 d(8~15 d),差异均无统计学意义(均P>0.05)。移植前≥完全缓解(CR)率为48.4%(31/64),移植后3个月≥CR率为70.3%(45/64),差异有统计学意义(χ2=6.35,P=0.012)。所有患者中位随访时间为27个月(2~67个月)。3年OS、PFS率分别为77.6%、54.9%;中位OS、PFS时间分别为67、52个月。中位住院时间为20 d(15~37 d)。无移植相关死亡患者,不良反应主要为胃肠道反应(100.0%,64/64)、4级血小板减少(98.4%,63/64)、4级中性粒细胞减少(96.9%,62/64)、粒细胞缺乏伴发热(40.6%,26/64)。结论ASCT对适合移植的MM患者有效,可进一步提高缓解率和缓解深度,延长患者PFS和OS时间,且不良反应可控。Objective To investigate the efficacy and safety of autologous hematopoietic stem cell transplantation(ASCT)in the treatment of multiple myeloma(MM).Methods The clinical data of 64 MM patients who received ASCT in the Second Affiliated Hospital of Xi'an Jiaotong University from October 2015 to March 2022 were retrospectively analyzed.The clinical characteristics,therapeutic effects and adverse reactions of the patients were summarized.Results Of the 64 patients,42 were male and 22 were female;the median age was 54 years old(37-69 years old).The median number of CD34+cells collected from 46 patients in the CE(cyclophosphamide,etoposide)regimen mobilization group and 17 patients in the plerixafor mobilization group were 7.50×106/kg[(1.15-24.73)×106/kg]and 4.54×106/kg[(0.75-10.40)×106/kg],and the difference was statistically significant(Z=3.02,P=0.024).Hematopoietic reconstitution was successful in all 64 patients,and the median time for white blood cell and platelet engraftment was 11 d(8-13 d)and 11 d(8-15 d),respectively.The patients'pretreatment regimens were all high-dose melphalan,the median white blood cell and platelet engraftment time of 29 patients in the oral group were 11 d(8-13 d)and 11 d(8-15 d),respectively,the median white blood cell and platelet engraftment time of 35 patients in the intravenous infusion group were 11 d(8-12 d)and 11 d(8-15 d),respectively,and there were no statistical differences(both P>0.05).The≥CR rate was 48.4%(31/64)before transplantation and 70.3%(45/64)three months after transplantation,and the difference was statistically significant(χ2=6.35,P=0.012).The median follow-up time of all patients was 27 months(2-67 months).The 3-year OS and PFS rates were 77.6%and 54.9%,and the median OS and PFS time were 67 and 52 months.The median hospitalization time was 20 d(15-37 d).There was no transplantation-related mortality,and the main adverse reactions were gastrointestinal reactions(100.0%,64/64),grade 4 thrombocytopenia(98.4%,63/64),grade 4 neutropenia,and agranulocytosis wit

关 键 词：多发性骨髓瘤 造血干细胞移植 造血干细胞动员 治疗结果 不良反应 

分 类 号：R733.3[医药卫生—肿瘤]