發(fā)布時間：2018-03-12 10:23

  本文選題：多發(fā)性骨髓瘤　切入點(diǎn)：自體造血干細(xì)胞移植　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討多發(fā)性骨髓瘤(multiple myeloma,MM)患者以司莫司汀、白消安和依托泊苷作為預(yù)處理方案行自體造血干細(xì)胞移植(autologous stem cell transplantation,ASCT)的安全性及療效分析。方法:對自2005年12月至2016年10月于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院和浙江省中醫(yī)院行自體造血干細(xì)胞移植的多發(fā)性骨髓瘤患者進(jìn)行回顧性分析,其中10例患者采用司莫司汀、白消安和依托泊苷(MeCCNU+Busulfan+VP16,MBV)方案行自體造血干細(xì)胞移植預(yù)處理(MBV組),15例患者采用大劑量馬法蘭(high-dose melphalan,HDM)行自體造血干細(xì)胞移植預(yù)處理(HDM組)。觀察比較兩種預(yù)處理方案的造血重建時間,毒性,移植后反應(yīng)率及隨訪分析長期生存情況。結(jié)果:兩組患者基本資料如性別比例、MM分型、ISS分期、Dufie-Salmon分期無顯著差異,兩組患者中接受包含≥2療程硼替佐米、包含2療程硼替佐米誘導(dǎo)緩解化療方案的患者比例亦無顯著差異。兩組患者移植前輸注單個核細(xì)胞數(shù)、CD34陽性細(xì)胞數(shù)無顯著差異。MBV組與HDM組比較,中位中性粒細(xì)胞植入時間分別為10(8-11)天和12(9-24)天,P0.001,中位血小板植入時間分別為12(8-11)天和14(11-33)天,P=0.001,有顯著統(tǒng)計學(xué)差異。兩組患者預(yù)處理不良反應(yīng)譜相似,差異無統(tǒng)計學(xué)意義,兩組患者均無肝靜脈阻塞病和移植早期相關(guān)死亡(transplant-relate mortality,TRM)發(fā)生。MBV組、HDM組患者移植前完全緩解率均為40%,移植后完全緩解率分別提高至60%和53.33%,差異無統(tǒng)計學(xué)意義。移植后對兩組患者進(jìn)行隨訪,MBV組患者移植后中位隨訪期23.9(7.7-34.1)月,其中3例(30%)患者出現(xiàn)疾病進(jìn)展,余7例患者均為緩解狀態(tài)。隨訪至2017年2月28日,有1例患者死于疾病進(jìn)展,余9例患者存活。HDM組患者中位隨訪期42.2(10.7-95.2)月,其中10例(66.67%)患者出現(xiàn)疾病進(jìn)展,隨訪至2017年2月28日,8例患者移植后死亡,除1例患者死于化膿性腦膜炎,余7例均死于疾病進(jìn)展。MBV組與HDM組患者2年無進(jìn)展生存(progress-free survival,PFS)分別為64%和66.7%,P=0.585,2年總生存(overall survival,OS)分別為和90%和80%,P=0.708,均無統(tǒng)計學(xué)差異。結(jié)論:以司莫司汀、白消安和依托泊苷預(yù)處理方案行自體造血干細(xì)胞移植是治療多發(fā)性骨髓瘤安全有效的、耐受性好的的方法,其在多發(fā)性骨髓瘤患者自體造血干細(xì)胞移植中的應(yīng)用有待大樣本前瞻性隨機(jī)對照研究進(jìn)一步證實(shí)。
[Abstract]:Objective: to investigate the efficacy of simvastatin in patients with multiple myeloma with multiple myeloma (MM). The safety and efficacy of autologous stem cell transplanationASCT in autologous hematopoietic stem cell transplantation were analyzed in the second affiliated Hospital of Zhejiang University School of Medicine from December 2005 to October 2016 and Zhejiang Province, Zhejiang Province, from December 2005 to October 2016 in the second affiliated Hospital of Zhejiang University School of Medicine. The patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation in provincial Chinese medicine hospital were retrospectively analyzed. Among them, 10 patients were treated with Smolastine. Baxuan and etoposide MeCCNU Busulfan VP16 (MBV) regimen were used to pretreat 15 patients with autologous hematopoietic stem cell transplantation (AHSCT), 15 patients were treated with high-dose hemopoietic stem cell transplantation (HDM), and the hematopoietic reconstitution time of the two preconditioning protocols was observed and compared. Results: there was no significant difference between the two groups in basic data such as sex ratio, MM classification and ISS stage and Dufie-Salmon stage. The patients in the two groups received bortezomil containing more than 2 courses of treatment. There was no significant difference between the two groups in the number of mononuclear cells and the number of CD34 positive cells before transplantation. There was no significant difference in the number of CD34 positive cells between the MBV group and the HDM group, and there was no significant difference in the number of CD34 positive cells between the MBV group and the HDM group. The median neutrophil implantation time was 108-11 days and 129-24 days, the median platelet implantation time was 128-11 days and 141133) days, respectively. There was significant difference between the two groups. The adverse reaction spectrum of pretreatment was similar between the two groups, but there was no significant difference between the two groups. There was no hepatic vein occlusion and transplant-related mortality (TRM) in both groups. The complete remission rate before transplantation was 40 in the MBV group, and the complete remission rate increased to 60% and 53.33 after transplantation, respectively. There was no significant difference after transplantation. The median follow-up period of the patients in the MBV group was 23.9- 7.7-34.1 months, and the patients in the MBV group were followed up for 7.7-34.1 months. Among them, 3 patients developed disease progression, the other 7 patients were in remission state, 1 patient died of disease progression until February 28th 2017, and the remaining 9 patients in the HDM group had a median follow-up period of 42.2 months, 10.7-95.2 months, while the other 9 patients in the HDM group had a median follow-up period of 42.2 months or 10.7-95.2 months. Ten of them (66.67) developed disease progression, followed up until February 28th 2017 in 8 patients died after transplantation, except for one patient who died of suppurative meningitis. The other 7 patients died of disease progression. The two year progressive survival progress-free survival (PFSs) in the MBV group and the HDM group were 64% and 66.7, respectively, and the total survival rate in the two years was 90% and 0.708.There was no statistical difference between the two groups. Conclusion: there is no significant difference between the two groups. Autologous hematopoietic stem cell transplantation with Pretreatment regimen and etoposide regimen is a safe, effective and well tolerated method for the treatment of multiple myeloma. Its application in autologous hematopoietic stem cell transplantation in multiple myeloma patients needs to be further confirmed by a large prospective randomized controlled study.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.3

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相關(guān)期刊論文 前1條

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本文編號：1601147