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首页> 外文期刊>Folia histochemica et cytobiologica >Treatment of multiple myeloma patients with autologous stem cell transplantation - a fresh analysis
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Treatment of multiple myeloma patients with autologous stem cell transplantation - a fresh analysis

机译：自体干细胞移植治疗多发性骨髓瘤患者的最新分析

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摘要

Patients with multiple myeloma (MM) treated with conventional chemotherapy have an average survival of approximately three years. High dose chemotherapy followed by autologous stem cell transplantation (ASCT), first introduced in the mid-1980s, is now considered the standard therapy for almost all patients with multiple myeloma, because it prolongs overall survival and disease free survival. Between November 1997 and October 2006, 122 patients with MM (58 females, 64 males, median age 51.0 years [± 7.98] range: 30-66 years) were transplanted in the Department of Hematooncology and Bone Marrow Transplantation at the Medical University of Lublin: 47 patients were in complete remission or in unconfirmed complete remission, 66 patients were in partial remission, and nine had stable disease. Of these, there were 95 patients with IgG myeloma, 16 with IgA myeloma, one with IgG/IgA, one with IgM myeloma, five with non secretory type, two with solitary tumor and two with LCD myeloma. According to Durie-Salmon, 62 patients had stage III of the disease, 46 had stage II and four had stage I. Most patients (69/122) were transplanted after two or more cycles of chemotherapy, 48 patients were transplanted after one cycle of chemotherapy, one patient after surgery and rtg- -therapy and four patients had not been treated. In mobilisation procedure, the patients received a single infusion of cyclophosphamide (4-6 g/m 2) or etoposide 1.6 g/m 2 followed by daily administration of G-CSF until the peripheral stem cells harvest. The number of median harvest sessions was 2.0 (± 0.89) (range: 1-5). An average of 7.09 (± 33.28) × 10 6 CD34 + cells/kg were collected from each patient (range: 1.8-111.0 × 10 6/kg). Conditioning regimen consisted of high dose melphalan 60-210 mg/m2 without TBI. An average of 3.04 (± 11.59) × 10 6 CD34 + cells/kg were transplanted to each patient. Fatal complications occured in four patients (treatment- -related mortality = 3.2%). In all patients there was regeneration of hematopoiesis. The median number of days for recovery to ANC 0.5 × 10 9/l was 13 (± 4.69) (range: 10-38) and platelets recovery to 50 × 10 9/l was 25 days (± 11.65) (range: 12-45). Median time of hospitalization was 22 days (± 7.14) (range: 14-50). Patients were evaluated on day 100 after transplantation: 74.9% achieved CR and nCR, 14.3% were in PR, 5.4% had SD and 5.4% had progressed. Median of OS was 45 months (± 30.67). OS at 3-years was 84% and at 7-years 59%. Median PFS was 25 months (± 26.13). PFS at 3-years was 68%, and at 7-years was 43%. At present (November 2009) 52 patients (42%) are still alive. High-dose chemotherapy followed by autologous stem cell transplantation is a valuable, well tolerated method of treatment for patients with MM that allows the achievement of long- -lasting survival.
机译：接受常规化学疗法治疗的多发性骨髓瘤（MM）患者的平均生存期约为三年。高剂量化疗后自体干细胞移植（ASCT）于1980年代中期首次引入，现在已被认为是几乎所有多发性骨髓瘤患者的标准疗法，因为它可以延长总体生存期和无病生存期。在1997年11月至2006年10月之间，在卢布林医科大学血液学和骨髓移植系移植了122例MM患者（58例女性，64例男性，中位年龄51.0岁[±7.98]范围：30-66岁）。 ：47例完全缓解或未经证实的完全缓解，66例部分缓解，9例病情稳定。其中，有95例IgG骨髓瘤，16例IgA骨髓瘤，1例IgG / IgA，1例IgM骨髓瘤，5例非分泌型，2例孤立性肿瘤和2例LCD骨髓瘤。根据Durie-Salmon的研究，该病为III期的62例患者，II期为46例，I期为4例。大多数患者（69/122）在两个或两个以上化疗周期后被移植，48例在一个周期的化疗后被移植。化疗，一名手术后接受rtg治疗的患者和四名未经治疗的患者。在动员过程中，患者接受单次环磷酰胺（4-6 g / m 2）或依托泊苷1.6 g / m 2的输注，然后每天服用G-CSF直至外周干细胞收获。收获中间次数为2.0（±0.89）（范围：1-5）。从每位患者中平均收集到7.09（±33.28）×10 6 CD34 +细胞/ kg（范围：1.8-111.0×10 6 / kg）。调理方案由不使用TBI的高剂量美法仑60-210 mg / m2组成。每位患者平均移植了3.04（±11.59）×10 6 CD34 +细胞/ kg。致命并发症发生在四名患者中（与治疗有关的死亡率= 3.2％）。所有患者均出现造血再生。恢复到ANC> 0.5×10 9 / l的中位数天数是13（±4.69）（范围：10-38），而恢复到> 50×10 9 / l的血小板是25天（±11.65）（范围： 12-45）。住院中位时间为22天（±7.14）（范围：14-50）。在移植后第100天评估患者：CR和nCR达到74.9％，PR达到14.3％，SD达到5.4％，进展为5.4％。 OS中位数为45个月（±30.67）。 3年的OS为84％，7年的OS为59％。 PFS中位数为25个月（±26.13）。 3年时的PFS为68％，而7年时的PFS为43％。目前（2009年11月），有52名患者（42％）还活着。大剂量化疗后进行自体干细胞移植是一种非常有价值的，耐受性良好的MM患者治疗方法，可实现长期生存。

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