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目的了解新药硼替佐米(Bor)治疗条件下自体造血干细胞移植(AHCT)治疗多发性骨髓瘤(MM)的安全性及疗效。方法回顾性分析我科2008年3月-2010年4月18例符合条件MM患者进行AHCT的安全性与疗效。结果 18例AHCT预处理方案:大剂量马法兰(HDM)8例,Bor联合HDM(Bor-HDM)10例。8例诱导治疗和移植预处理方案均应用Bor治疗,8例诱导治疗时应用Bor而移植预处理方案未应用,2例诱导治疗未应用而移植预处理应用Bor。HDM和Bor-HDM组移植中恶心、呕吐、厌食、腹泻、口腔黏膜炎及发热均无统计学差异(P>0.1)。移植后粒系重建中位时间HDM组12d,Bor-HDM组13d(P>0.1);血小板重建中位时间HDM组16.5d,Bor-HDM组18d(P>0.1)。移植后14例接受反应停维持治疗。随访25(14-39)月,11例出现疾病进展,进展时间6-25月;HDM组进展4例,Bor-HDM进展6例(P>0.1)。AHCT后2年无疾病进展生存率为(44.2±12)%。结论新药硼替佐米治疗条件下MM进行AHCT安全、易行,但移植后仍易出现疾病进展。
Objective To investigate the safety and efficacy of autologous hematopoietic stem cell transplantation (AHCT) in the treatment of multiple myeloma (MM) under the new drug bortezomib (Bor). Methods Retrospective analysis of our department from March 2008 to April 2010 18 cases of eligible patients with MM for the safety and efficacy of AHCT. Results 18 cases of AHCT pretreatment program: high-dose melphalan (HDM) in 8 cases, Bor combined with HDM (Bor-HDM) in 10 cases. 8 cases of induction therapy and transplantation of pretreatment program were treated with Bor, 8 cases of induction therapy Bor without transplantation pretreatment program did not apply, 2 cases of induction therapy without application of transplantation pretreatment Bor. Nausea, vomiting, anorexia, diarrhea, oral mucositis and fever in HDM and Bor-HDM group were not significantly different (P> 0.1). After transplanting, the median time for rebuilding of the granulocytes was 12 days in the HDM group and 13 days in the Bor-HDM group (P> 0.1). The median time to platelet reorganization was 16.5 days in HDM group and 18 days in Bor-HDM group (P> 0.1). After transplantation, 14 patients received response stop maintenance therapy. Follow-up 25 (14-39) months, 11 cases of disease progression, progression time 6-25 months; HDM group progressed in 4 cases, Bor-HDM progress in 6 cases (P> 0.1). The disease-free survival rate after 2 years of AHCT was (44.2 ± 12)%. Conclusion The new drug bortezomib MM treatment under the conditions of safe, safe, but still prone to disease progression after transplantation.