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目的:多发性骨髓瘤(multiple myeloma,MM)至今仍不可治愈,几乎所有病人均会出现复发或难治,本文初步探讨硼替佐米应用于难治性MM患者PAD化疗并序贯自体外周血造血干细胞移植(autologous pe-ripheral blood stem cell t ransplantation,APBSCT)的可行性和疗效。方法:采用PAD(硼替佐米+阿霉素+地塞米松)方案治疗复发或难治性MM。结果:22例中3例难治MM患者给予PAD方案化疗4-6个疗程后,2例达到接近完全缓解(nCR),1例达到部分缓解(VGPR),并随后行APBSCT,动员方案PAD+CTX(PAD,环磷酰胺1.5g/m2,d15)联合G-CSF。预处理方案为马法兰140mg/m2。移植后采用沙利度胺100mg/天。所有患者在移植前均达到CR或VGPR,干细胞采集充分,安全有效,移植后造血功能均快速顺利重建。无1例死亡。移植后采用沙利度胺维持,随访3-12个月,病情稳定。结论:PAD用于难治MM患者的治疗达CR后,继续序贯进行APBSCT不仅可行,而且PAD不影响正常造血干细胞动员,故采用PAD和序贯用PAD+CTX动员方案的APBSCT的治疗手段,为难治MM患者的治疗提供新的治疗手段。但对长期生存的改善作用需进一步研究。
OBJECTIVE: Multiple myeloma (MM) remains untreated until now, and almost all patients will have recurrent or refractory disease. This study explored the clinical effects of bortezomib in the treatment of refractory MM with PAD chemotherapy and sequential autologous peripheral blood hematopoiesis Feasibility and efficacy of autologous pe-ripheral blood stem cell transplantation (APBSCT). Methods: PAD (bortezomib + doxorubicin + dexamethasone) regimen for the treatment of relapsed or refractory MM. RESULTS: Of the 22 patients with refractory MM treated with PAD regimen for 4-6 courses of chemotherapy, 2 achieved near complete remission (nCR) and 1 achieved partial remission (VGPR), followed by APBSCT, mobilization regimen PAD + CTX (PAD, cyclophosphamide 1.5 g / m2, d15) in combination with G-CSF. Pretreatment program for melphalan 140mg / m2. Thalidomide 100mg / day after transplantation. All patients reached CR or VGPR before transplantation. The stem cells were collected safely and effectively, and the hematopoietic function of the patients were quickly and successfully reconstructed. No one died. Thalidomide maintenance after transplantation, followed up for 3-12 months, his condition was stable. CONCLUSIONS: After the treatment of refractory MM with refractory MM patients, continuous sequential APBSCT is not only feasible, but also PAD does not affect the mobilization of normal hematopoietic stem cells. Therefore, the treatment of PAD and sequential sequential mobilization of PAD + CTX with APBSCT, For the treatment of refractory MM patients with new treatment methods. However, the long-term survival improvement needs further study.