T - VAD 方案联合自体外周血造血干细胞移植治疗多发性骨髓瘤的疗效观察

目的：观察 T - VAD 方案联合自体外周血造血干细胞移植（ autologous peripheral blood hematopoietic stem cells，APBSC）治疗多发性骨髓瘤（multiple myeloma，MM）的临床疗效及不良反应。方法：选取2010年1月-2014年12月采用 T - VAD 方案联合自体外周血造血干细胞移植治疗的30例多发性骨髓瘤患者的临床资料进行回顾性研究。T - VAD 方案：沙利度胺起始剂量为50mg/晚，每周增加50～100mg/晚，最大剂量200mg/晚，若无明显不适，持续服用。长春新碱0.4mg/ d，静脉滴注，第1～4d；多柔比星10mg/（m2·d），静脉滴注，第1～4d；地塞米松40mg/ d，静脉滴注，第1～4d，第9～12d，28d 为一个疗程，共4个疗程。T - VAD 方案4个疗程诱导治疗后给予自体外周血造血干细胞采集、移植术。结果：患者移植术后，造血功能均顺利重建，无移植相关的死亡发生。30例患者在移植后3个月，完全缓解10例（33.3%），高质量缓解（非常好的部分反应，VGPR）16例（53.3%），部分反应2例（6.6%），无变化2例（6.6%）。不良反应主要有不同程度的恶心、呕吐、脱发及骨髓抑制等。结论：T - VAD 联合自体外周血造血干细胞移植治疗多发性骨髓瘤疗效明显，患者耐受性好。

The efficacy of combinative treatment of T - VAD regimen and autologous peripheral blood hematopoietic stem cell transplantation in multiple myeloma

Objective:To study the clinical efficacy and side effects of T - VAD regimen combined with autologous peripheral blood hematopoietic stem cells transplantation(APBSCT)for multiple myeloma( MM). Methods:From January 2010 to December 2014,30 patients with MM,who received thalidomide and VAD regimen combined with au-tologous peripheral blood hematopoietic stem cell transplantation,were enrolled. All patients were treated with thalido-mide on dose of 50mg/ night at the first week,increased dose by 50mg/ night weekly,up to the maximum dose of 200mg/ night,if the patient could tolerant),and Vincristine 0. 4mg/ d for 4 days and Doxorubicin 10mg/(m2 ·d)for 4 days,dexamethasone 40mg/ d for 4 days. Dexamethasone was also given on days 9 to 12 of the first cycle of treat-ment. The regimen was administered every 4 weeks for four courses. After 4 courses of T - VAD regimen,the patient was given autologous peripheral blood hematopoietic stem cell collection,and transplantation. Results:After transplan-tation,all 30 patients resumed the normal blood cell production,and had no transplantation related mortality. 10 pa-tients(33. 3% )achieved complete,16 patients(53. 3% )very good partial responses. 2 patients(6. 6% )showed mi-nor response or improved,and 2patients(6. 6% )were rated as non - responders. The major grade of toxicities and side effects consisted of pulmonary infection,constipation,drowsiness,and peripheral neuritis. Conclusion:T - VAD regimen combined with APBSCT was an effective and well - tolerant cytoreductive treatment.