引用本文:谢艳梅,黄玉葵,黄彩献,王八连,陆晓晨,彭政棉,韦 琼,石仁州,罗 静,汤杨明,李 含,李学军,蓝 梅.大剂量美法仑预处理方案在多发性骨髓瘤自体造血干细胞移植中的疗效及安全性分析[J].中国临床新医学,2023,16(11):1142-1147.
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大剂量美法仑预处理方案在多发性骨髓瘤自体造血干细胞移植中的疗效及安全性分析
谢艳梅,黄玉葵,黄彩献,王八连,陆晓晨,彭政棉,韦 琼,石仁州,罗 静,汤杨明,李 含,李学军,蓝 梅
530021 南宁,广西壮族自治区人民医院(广西医学科学院)血液内科
摘要:
[摘要] 目的 分析大剂量美法仑预处理方案在多发性骨髓瘤(MM)自体造血干细胞移植中的疗效及安全性。方法 回顾性分析2006年10月至2023年7月在广西壮族自治区人民医院血液内科行大剂量美法仑预处理方案自体造血干细胞移植的64例MM患者的临床资料。分析患者造血重建情况、移植后疾病转归及移植相关不良反应。结果 64例MM患者均获得造血重建,中性粒细胞植入中位时间为11(9~13)d,血小板植入中位时间为12(10~14)d,移植后100 d移植相关死亡率(TRM)为0。至随访结束,随访时间为4~188个月,中位随访时间为42.3(3.5~188)个月,中位生存时间未达到,总生存率为89.06%。64例MM患者中,疾病无进展46例(71.88%),疾病复发或进展18例(28.12%),死亡7例(10.94%),其中6例(9.38%)死于疾病复发或进展,1例(1.56%)死于继发急性白血病。移植后3个月达CR的患者52例(81.25%),至随访结束无疾病复发或进展41例(64.06%)。大剂量美法仑预处理方案的非血液学毒性主要为恶心呕吐、口腔黏膜炎、腹泻。64例MM患者均发生恶心呕吐,其中1~2级54例(84.38%),3~4级10例(15.63%);口腔黏膜炎1~2级20例(31.25%),3~4级7例(10.94%);腹泻1~2级13例(20.31%),3~4级4例(6.25%)。另外,38例(59.38%)患者中性粒细胞缺乏期间出现感染性发热,给予对症治疗后均好转,无移植相关死亡事件发生。结论 大剂量美法仑预处理方案用于MM自体造血干细胞移植临床疗效显著,副作用可以耐受。
关键词:  大剂量美法仑  多发性骨髓瘤  自体造血干细胞移植  预处理
DOI:10.3969/j.issn.1674-3806.2023.11.08
分类号:
基金项目:广西卫生健康委自筹经费科研课题(编号:Z-A20220096)
Analysis on the clinical efficacy and safety of high-dose melphalan pretreatment regimen in autologous hematopoietic stem cell transplantation for multiple myeloma
XIE Yan-mei, HUANG Yu-kui, HUANG Cai-xian, et al.
Department of Hematology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
Abstract:
[Abstract] Objective To analyze the clinical efficacy and safety of high-dose melphalan pretreatment regimen in autologous hematopoietic stem cell transplantation for multiple myeloma(MM). Methods The clinical data of 64 patients with MM who received high-dose melphalan pretreatment regimen in autologous hematopoietic stem cell transplantation for MM in the Department of Hematology of the People′s Hospital of Guangxi Zhuang Autonomous Region from October 2006 to July 2023 were retrospectively analyzed. The patients′ hematopoietic reconstruction, disease outcomes after transplantation and transplant-related adverse reactions were analyzed. Results Hematopoietic reconstruction was achieved in all the 64 patients with MM. The median time of neutrophil implantation was 11(9-13)days, and the median time of platelet implantation was 12(10-14)days, and the transplant-related mortality(TRM) was 0 one hundred days after transplantation. Until the end of follow-up, the follow-up period was 4-188 months, with a median follow-up time of 42.3(3.5-188)months, and the median overall survival was not reached. The overall survival rate was 89.06%. Among the 64 patients with MM, 46 patients(71.88%) had progression-free survival, and 18 patients(28.12%) had the disease recurrence or progression, and 7 patients(10.94%) died. Of the seven deaths, 6 cases(9.38%) died of the disease recurrence or progression, and 1 case(1.56%) died of secondary acute leukemia. Fifty-two patients(81.25%) achieved complete response(CR) 3 months after transplantation, and 41 patients(64.06%) had no disease recurrence or progression by the end of the follow-up. The main non-hematologic toxicities in the patients receiving the high-dose melphalan pretreatment regimen in autologous hematopoietic stem cell transplantation for MM were nausea and vomiting, oral mucositis, and diarrhea. Nausea and vomiting occurred in all the 64 patients with MM, including 54 cases(84.38%) of nausea and vomiting grades 1-2, 10 cases(15.63%) of nausea and vomiting grades 3-4, 20 cases(31.25%) of oral mucositis grades 1-2, 7 cases(10.94%) of oral mucositis grades 3-4, 13 cases(20.31%) of diarrhea grades 1-2 and 4 cases(6.25%) of diarrhea grades 3-4. In addition, 38 patients(59.38%) developed infectious fever during neutrophil deficiency, and these patients improved after symptomatic treatments, and no transplant-related deaths occurred. Conclusion The high-dose melphalan pretreatment regimen has significant clinical efficacy and tolerable side effects in autologous hematopoietic stem cell transplantation for MM.
Key words:  High-dose melphalan(HDM)  Multiple myeloma(MM)  Autologous hematopoietic stem cell transplantation(auto-HSCT)  Pretreatment