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）

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 pe-ripheral blood stem cell t ransplantation,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。

PAD therapy as induction treatment prior to autologous stem cell transplantation for relapsed/refractory multiple myeloma

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.