大剂量美法仑联合自体造血干细胞移植治疗多发性骨髓瘤的临床分析  

Clinical Analysis of High-Dose Melphalan Combined with Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

作　　者：韦中玲[1] 张岚鑫 黄辰 陈彩婷 李光羲 黄东平[1] 黄来全[1] WEI Zhong-Ling;ZHANG Lan-Xin;HUANG Chen;CHEN Cai-Ting;LI Guang-Xi;HUANG Dong-Ping;HUANG Lai-Quan(Department of Hematology,Yijishan Hospital,Wannan Medical College,Wuhu 241001,Anhui Province,China;Department of Clinical Teaching,Yijishan Hospital,Wannan Medical College,Wuhu 241001,Anhui Province,China)

机构地区：[1]皖南医学院弋矶山医院血液科,安徽芜湖241001 [2]皖南医学院弋矶山医院临床教学部,安徽芜湖241001

出　　处：《中国实验血液学杂志》2024年第6期1752-1758,共7页Journal of Experimental Hematology

基　　金：皖南医学院弋矶山医院三新项目(Z22009);皖南医学院教学质量与教学改革工程项目(2022jyxm78);2022年度安徽省新时代育人质量工程项目(2022zyxwjxalk160);安徽省教育厅自然科学研究重点项目(2022AH051217)。

摘　　要：目的:探讨大剂量美法仑联合自体造血干细胞移植治疗多发性骨髓瘤的安全性、疗效和预后。方法:回顾2020年3月至2022年10月在皖南医学院弋矶山医院血液科进行自体移植一线巩固治疗的17例初诊多发性骨髓瘤患者的临床资料,分析治疗的安全性、疗效和预后。结果:17例患者中,男性10例,女性7例,中位年龄56(45-64)岁。干细胞植入率100%,中性粒细胞中位植入时间为+10(9-12)d,血小板中位植入时间为+12(10-21)d。口腔黏膜炎及肠道感染发生率100%,肺部感染2例,泌尿系感染1例,皮肤感染1例;11例患者发生血清淀粉酶一过性升高。移植后评估13例获得CR以上疗效,CR率较移植前有提高趋势(13/17 vs 8/17;P=0.078)。中位随访18(6-36)个月,15例无进展存活,1例出现疾病进展,1例因临床复发放弃治疗而死亡,2年OS率约90.0%,2年PFS率约83.9%。结论:大剂量美法仑联合自体造血干细胞移植一线巩固治疗多发性骨髓瘤能加深患者缓解深度,进一步提高疗效,而且移植相关并发症可控,值得在临床中推广。Objective:To investigate the safety,efficacy,and prognosis of high-dose melphalan in combination with autologous hematopoietic stem cell transplantation(ASCT)for the treatment of multiple myeloma(MM).Methods:The clinical data of 17 patients with newly diagnosed MM who underwent ASCT as first-line consolidation therapy at the Yijishan Hospital of Wannan Medical College from March 2020 to October 2022 were retrospectively analyzed.The safety,efficacy,and prognosis of this treatment approach were evaluated.Results:Of the 17 patients,10 were male and 7were female,with a median age of 56(45-64)years.The stem cell engraftment rate was 100%,with a median neutrophil engraftment time of+10(9-12)days and a median platelet engraftment time of+12(10-21)days.The incidence of oral mucositis and intestinal infection after transplantation was 100%,with 2 cases of pulmonary infection,1 case of urinary tract infection,1 case of skin infection,and 11 cases of transient elevation of serum amylase.After transplantation,13patients achieved a complete response(CR)or better,and the CR rate showed an increasing trend compared to before transplantation(13/17 vs 8/17;P=0.078).The median follow-up time was 18(6-36)months,and 15 patients survived without progression,1 patient experienced disease progression,and 1 patient died due to clinical relapse and abandonment of treatment.The 2-year overall survival(OS)rate and progression-free survival(PFS)rate were approximately 90.0%and 83.9%,respectively.Conclusion:High-dose melphalan in combination with ASCT as first-line consolidation therapy for MM can enhance the depth of patient response,further improve therapeutic efficacy,and the transplant-related complications are controllable,making it a viable option worth promoting in clinical practice.

关 键 词：多发性骨髓瘤 自体造血干细胞移植 疗效 大剂量美法仑 复发 

分 类 号：R733.3[医药卫生—肿瘤]