PAD序贯自体造血干细胞移植治疗难治多发性骨髓瘤(附22例)

摘要

目的:多发性骨髓瘤(multiple myeloma,MM)至今仍不可治愈,几乎所有病人均会出现复发或难治,本文初步探讨硼替佐米应用于难治性MM患者PAD化疗并序贯自体外周血造血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)的可行性和疗效.方法:采用PAD(硼替佐米+阿霉素+地塞米松)方案治疗复发或难治性MM.结果:22例中3例难治MM患者给予PAD方案化疗4-6个疗程后,2例达到接近完全缓解(nCR),1例达到部分缓解(VGPR),并随后行APBSCT,动员方案PAD+CTX(PAD,环磷酰胺1.5g/m2,d15)联合G-CSF.预处理方案为马法兰140mg/m2.移植后采用沙利度胺100mg/天.所有患者在移植前均达到CR或VGPR,干细胞采集充分,安全有效,移植后造血功能均快速顺利重建.无1例死亡.移植后采用沙利度胺维持,随访3-12个月,病情稳定.结论:PAD用于难治MM患者的治疗达CR后,继续序贯进行APBSCT不仅可行,而且PAD不影响正常造血干细胞动员,故采用PAD和序贯用PAD+CTX动员方案的APBSCT的治疗手段,为难治MM患者的治疗提供新的治疗手段.但对长期生存的改善作用需进一步研究.%Objective:To evaluate the therapeutic efficacy and toxicity of PAD therapy as induction treatment prior to autologous peripheral stem cell transplantation( APBSCT ) for elapsed/refractory multiple myeloma( MM ).Methods: We used PAD( bortezomib + doxorubicin + Dexamethasone ) to treat elapsed/refractory MM as induction therapy.Results: Thereinto was used in three patients by 4 - 6 cycles of PAD, and 2 obtained complete remission ( nCR ), 1 partial remission( VGPR ).Subsequently combined PAD and cyclophosphamide followed by G - CSF was used for mobilization regimen.APBSCT were collected when white blood cell ( WBC ) ＞ 10.0 × 109/L.The conditioning regimen was high - dose melphalan ( 140mg/m2 ).Post - APBSCT maintenance was thalidomide 100mg/d.Induction pre - transplantation treatment with PAD could increase the CR + VGPR rate before APBSCT.3 patients in which a successful mobilization of peripheral stem cells was obtained with PAD + cyclophosphamide and G - CSF.The patients underwent APBSCT showing a rapid and complete post - transplant hematological recovery/hematopoietic reconstitution.No toxic deaths were observed.After APBSCT maintenance with thalidomide improves the response rate.With a follow - up time of 3 to 12 months, patients achieved complete remission ( CR ).Conclusion: Our experience suggests that PAD is not only very effective for patients with relapsed or refractory MM, but also an effective therapy without negative impact on stem cell mobilization.It is a new strategy for elapsed/refractory MM that the patients have received PAD then proceed to APBSCT.Owing to limited follow - up, it is unclear whether these higher response rates translate into increased survival.