选择性CD34+细胞和非选择性自体外周血干细胞移植治疗多发性骨髓瘤的比较研究

目的明确选择性CD34+细胞自体外周血干细胞移植(APBSCT)治疗多发性骨髓瘤(MM)的临床效果.方法对21例接受CD34+细胞APBSCT治疗的MM患者(选择组)和另外21例接受非选择性APBSCT的MM患者(对照组)的造血恢复时间、有效率、生存率、移植相关不良反应、移植费用进行比较.两组病例在年龄、初诊时血清β2微球蛋白水平和移植时疾病状态均具有可比性,诱导治疗及预处理方案基本相同.结果与对照组相比,选择组患者回输的CD34+细胞数显著偏低对照组和选择组分别为9.4(1.1～15.0)×106/kg和2.2(0.5～14.3)×106/kg](P＜0.001),中性粒细胞恢复至≥0.5×109/L和血小板恢复至≥20×109/L儿的中位时间,在选择组分别为10d和9d,对照组分别为9.5d(P=0.357)和4.5d(P=0.005).两组的治疗有效率相似(选择组85.7%,对照组90.4%),3年无病生存率(选择组和对照组分别为32%和39%)和总生存率(选择组和对照组分别为85%和79%)两组相比差异无显著性,而且使用非选择性APBSCT可明显降低移植费用.结论选择性CD34+细胞APBSCT与非选择性APBSCT相比,并不能改善MM的临床治疗结果,而且移植费用更大.

Autologous peripheral blood selected CD34+ cell transplantation in the treatment of multiple myeloma

OBJECTIVE: To investigate the clinical impact of CD(34)(+) cell selected autologous peripheral blood stem cell transplantation (APBSCT) in multiple myeloma (MM). METHODS: The hematopoietic recovery time, treatment efficacy, survival rate, transplantation related mobidity and the cost were compared between 21 MM patients receiving CD(34)(+) APBSCT and 21 MM patients receiving unselected APBSCT. The age and beta(2) microglobulin level at diagnosis and disease status at the time of transplantation were similar in the two groups. The induction treatment and conditioning regimen were the same. RESULTS: Significantly lower CD(34)(+) cells were infused in the selected group as compared with the control group: 2.2 (0.5 - 14.3) x 10(6)/kg vs 9.4 (1.1 - 15.0) x 10(6)/kg, (P < 0.001). The median times to neutrophil >or= 0.5 x 10(9)/L and platelet >or= 20 x 10(9)/L were 10 and 9 days for the selected group, and 9.5 (P = 0.357) and 4.5 days (P = 0.005) for the control group, respectively. Response rates were similar in both groups (85.7% for the selected group vs 90.4% for the control group). Three year disease-free survival (32% for the selected group vs 39% for the control group) and overall survival rates (85% for the selected group vs 79% for the control group) were not significantly different. Furthermore, unselected APBSCT could reduce the cost for the transplantation. CONCLUSION: It shows that CD(34)(+) cell selected autologous transplantation is more expensive and does not improve the clinical outcome of patients with MM.