目的:探讨多发性骨髓瘤(MM)患者经多疗程化疗后,行自体外周血造血干细胞移植(APBSCT)的疗效.方法:14例MM患者采用VTD(硼替佐米+吡柔吡星+地塞米松)、VD(硼替佐米+地塞米松)方案进行移植前化疗.4～6个疗程后,行APBSCT.采用化疗(环磷酰胺+足叶乙甙)联合粒细胞集落刺激因子(G-CSF)方法动员外周血干细胞.预处理方案为硼替佐米+马法兰,移植后以沙利度胺维持治疗.结果:①移植前9例患者达到完全缓解(CR),3例为非常好的部分缓解(VGPR),2例部分缓解(PR).②移植后+12(+10～+15)天中性粒细胞＞0.5×109/L,+14(13～19)天血小板＞20×109/L,+21～+28天骨髓检查示完全缓解骨髓象.③移植后随访4～105个月,3例+5～+17个月复发后死亡,1例+46个月复发,遂行第2次APBSCT,目前已累计无病生存105个月,其余10例患者均无病生存.14例患者移植后中位无进展生存期(PFS)为45.5(4～105)个月.结论:MM患者经多疗程以硼替佐米为主方案化疗后进行APBSCT后,给予沙利度胺维持治疗可延长患者无病生存时间.%Objective:To evaluate the therapeutic effect of autologous peripheral blood stem cell transplantation (APBSCT) for multiple myeloma (MM).Methods:Fourteen cases of patients who were diagnosed as MM received 4～6 courses of chemotherapy such as VTD and VD before transplantation.Peripheral blood stem cell were mobilized by chemotherapy combined G-CSF.Condition regimen were Bortezomib combined melphalan.Thalidomide was used as maintenance treatment after APBSCT.Results:①Nine cases of patients got complete remission(CR),3 cases got very good partial remission (VGPR) and 2 cases got partial remission(PR) before APBSCT.②All patients got rapidly hematopoietic reconstruction.The median time of ANC recovery≥0.5 × 109 /L were + 12 (+ 10-+ 15) days,platelet recovery≥20 ×109/L were +14(+13-+19) days.Blood marrow showed recovering in +21-+28 days.③Following up 4-105 months,3 cases of patients remissed in +5 to +17 months,and deathed lastly.1 case remissed in +46 months,received seckend APBSCT,and progress free of survival (PFS) were 105 months.Other 10 cases of patients were PFS.Conclusion:After courses of bortezomib-based chemotherapy,APBSCT and maintenance treatment with thalidomide were favorable methods to prolong PFS with MM patients.
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