南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (9): 1420-1425.doi: 10.12122/j.issn.1673-4254.2021.09.19

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自体造血干细胞移植可改善多发性骨髓瘤患者的临床状态

宁雪琴，魏小磊，郭绪涛，韦 祁，黄 芬，范志平，许 娜，孙 竞，冯 茹，刘启发，魏永强   

  1. 南方医科大学南方医院血液科，广东 广州 510515
  • 出版日期:2021-09-20 发布日期:2021-09-30

Autologous stem cell transplantation improves outcomes of patients with multiple myeloma receiving proteasome inhibitors and lenalidomide treatment

NING Xueqin, WEI Xiaolei, GUO Xutao, WEI Qi, HUANG Fen, FAN Zhiping, XU Na, SUN Jing, FENG Ru, LIU Qifa, WEI Yongqiang   

  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Online:2021-09-20 Published:2021-09-30

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摘要： 目的 探究蛋白酶体抑制剂和来那度胺治疗下，自体造血干细胞移植（ASCT）对初发多发性骨髓瘤（MM）患者缓解深度和生存的影响。方法 回顾性收集2015年1月~2019年12月在南方医科大学南方医院接受蛋白酶体抑制剂和或来那度胺治疗的初发及适合移植的MM患者临床资料，按照患者是否接受自体干细胞移植分为移植组及未移植组。移植组纳入接受4~6疗程蛋白酶体抑制剂和或来那度胺为基础的诱导治疗后序贯ASCT的患者，未移植组纳入仅接受8疗程以上的蛋白酶体抑制剂和或来那度胺为基础的诱导及巩固的患者，比较两组患者的治疗疗效及生存的差异。结果 总共105例患者纳入研究，移植组48例 （45.7%）、未移植组57例（54.3%），两组患者在性别、年龄及4疗程诱导治疗后疗效等方面相似（P>0.05）。两组患者在首次复发前获得过的最佳缓解程度有统计学差异（P<0.001），移植组获得完全缓解（85.4% vs 54.4%，P=0.001））和完全缓解+非常好的部分缓解（95.8% vs 73.7%，P=0.002）的比例高于未移植组；截止2020年12月31日末次随访时，移植组和未移植组的中位无进展生存期（PFS）分别为未达到和 29 月（P=0.013），两组患者的中位总生存期（OS）均未达到，但移植组 OS 优于未移植组（P= 0.022）。结论 在新药时代，ASCT仍能进一步提高初发MM患者的缓解深度并改善患者的生存。

关键词: 多发性骨髓瘤；蛋白酶体抑制剂；来那度胺；自体干细胞移植

Abstract: Objective To evaluate the effect of autologous stem cell transplantation (ASCT) on treatment response and survival outcomes in patients with newly diagnosed multiple myeloma (MM) receiving treatments with proteasome inhibitors and lenalidomide. Methods We retrospectively collected the clinical data of newly diagnosed MM patients, who were eligible for ASCT and received proteasome inhibitors or lenalidomide-based treatment in our hospital from January, 2015 to December, 2019. The patients were divided into transplantation group and non-transplantation group, and in transplantation group, the patients received 4 to 6 courses of induction therapy with proteasome inhibitors or lenalidomide before ASCT, while those in the non-transplantation group received more than 8 courses of induction and consolidation therapy with proteasome inhibitors or lenalidomide-based regimens. The therapeutic efficacy and survival outcomes of the patinets were compared between the two groups. Results A total of 105 patients were enrolled in the study, including 48 (45.7% ) in transplantation group and 57 (54.3% ) in non-transplantation group. The two groups were matched for gender, age and treatment response after 4 courses of induction therapy (P>0.05). The rate of optimal response before relapse differed significantly between the two groups (P=0.000), and the patients receiving ASCT had significantly higher rates of complete response (85.4% vs 54.4% , P= 0.001) and very good partial response or better (95.8% vs 73.7%, P=0.002) than those without ASCT. At the end of follow-up, the median progression-free survival in the transplantation group was not reached, as compared with 29 months in the non-transplantation group (P=0.013). The median overall survival (OS) in the two groups was not reached, but the OS was better in the transplant group than in the non-transplant group (P=0.022). Conclusion ASCT can further improve the depth of remission and survival outcomes in patients with newly diagnosed MM receiving treatments with proteasome inhibitors and lenalidomide.

Key words: multiple myeloma; proteasome inhibitor; lenalidomide; autologous stem cell transplantation