造血干细胞移植治疗16例多发性骨髓瘤疗效分析

目的:评价造血干细胞移植(SCT)治疗多发性骨髓瘤(MM)患者的疗效。方法:回顾性分析我院SCT治疗16例D-S分期Ⅲ期MM患者。自体造血干细胞移植(ASCT)13例。2例原发耐药、2例ASCT后复发和1例高危患者接受HLA匹配同胞供者异基因造血干细胞移植(allo-SCT);其中4例应用清髓性预处理。采用NCI/SWOG(2004年前)和EBMT标准分析治疗反应。结果:共完成ASCT20例次,无移植相关死亡(TRM)。ASCT后均有效,9例获得完全缓解(CR),4例部分缓解(PR)。10例移植前CR/PR者,中位随访35(6～126)个月,3例复发/进展,中位总生存(OS)尚未达到[已超过35(6～119)个月],中位无进展生存(PFS)27(1～50)个月。3例ASCT前处于疾病稳定状态(SD)者分别于移植后11、7和5个月后复发/进展。Allo-SCT组1例预处理后早期TRM,余3例CR,1例PR。1例患者移植后4个月死于急性移植物抗宿主病(GVHD)合并严重肺感染;余3例生存分别已达39、41和14个月,其中仅后者仍持续PFS。结论:ASCT治疗MM耐受性好,能明显延长PFS和OS;原发难治患者ASCT仍有效,但PFS持续时间短暂。沙利度胺联合治疗用于移植前/后可能提高疗效。allo-SCT有效提高高危及复发/难治患者的治疗反应率。

The Analysis of Curative Effect on Hemapoietic Stem Cell Transplantation of 16 Patients with Multiple Myeloma

Objective: To evaluated the curative effect of hemopoietic stem cell transplantation (HSCT) for patients with a multiple myeloma (MM). Mehods: A retrospective analysis of 16 patients with a stage- Ⅲ Durine- Salmon multiple myeloma (MM), treated with HSCT, was conducted. Thirteen patients received autologous stem cell transplantation (ASCT). Besides, 2 patients with a primary and refractory symptom, 2 with a post- ASCT recurrence and 1 with high- risk MM received allogeneic stem cell transplantation (allo- SCT) from matched siblings, among which 4 received conventional myeloabla-tive allogeneic transplantation. Therapeutic reactions to the transplantations were evaluated based on the criteria of NCI/SWOG (before 2004) and EBMT. Results: A total of 20 case- times of ASCT have been completed, without transplantation- related mortality (TRM). All patients have reaction of the AS-CT, with complete remission (CR) in 9 patients and partial remission (PR) in 4. After a 35- month median follow- up (ranging from 6 to 126 months) was conducted for 10 of the 13 patients with a response to chemotherapy before ASCT, and relapse/progression occurred in 3 patients, the median overall survival (OS) have not been obtained (beyond 35 months now [ranging from 6 to 119 months]) and the median event- free survival (EFS) reached 27 months. Relapse or progression occurred in 3 cases, with stable disease (SD) before ASCT, 11, 7 and 5 months after transplantation, respectively. In the Allo- SCT group, early TRM occurred in 1 cases after pretreatment, complete response (CR) in the other 3, and partial response (PR) in 1. One of the cases died of acute graft- versus- host disease (GVHD) and seri-ous pneumonia 4 months after transplantation, and survival rates of the other 3 were 39, 41 and 14 months, respectively, among which EFS remained in the last patient. Conclusion: Our data shows that the ASCT is a safe and feasible treatment on the MM, which can significantly prolong the EFS and OS.Although ASCT is a useful salvage therapy for refractory MM, the EFS is transient. Thalidomide- based treatment, before and after ASCT, can improve the OR, PFS and OS. Allo- SCT may have a good thera-peutic reaction on the patients with high- risk, relapse and refractory symptoms.