司莫司

发布时间：2018-03-12 10:23

本文选题：多发性骨髓瘤　切入点：自体造血干细胞移植　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨多发性骨髓瘤(multiple myeloma,MM)患者以司莫司汀、白消安和依托泊苷作为预处理方案行自体造血干细胞移植(autologous stem cell transplantation,ASCT)的安全性及疗效分析。方法:对自2005年12月至2016年10月于浙江大学医学院附属第二医院和浙江省中医院行自体造血干细胞移植的多发性骨髓瘤患者进行回顾性分析,其中10例患者采用司莫司汀、白消安和依托泊苷(MeCCNU+Busulfan+VP16,MBV)方案行自体造血干细胞移植预处理(MBV组),15例患者采用大剂量马法兰(high-dose melphalan,HDM)行自体造血干细胞移植预处理(HDM组)。观察比较两种预处理方案的造血重建时间,毒性,移植后反应率及随访分析长期生存情况。结果:两组患者基本资料如性别比例、MM分型、ISS分期、Dufie-Salmon分期无显著差异,两组患者中接受包含≥2疗程硼替佐米、包含2疗程硼替佐米诱导缓解化疗方案的患者比例亦无显著差异。两组患者移植前输注单个核细胞数、CD34阳性细胞数无显著差异。MBV组与HDM组比较,中位中性粒细胞植入时间分别为10(8-11)天和12(9-24)天,P0.001,中位血小板植入时间分别为12(8-11)天和14(11-33)天,P=0.001,有显著统计学差异。两组患者预处理不良反应谱相似,差异无统计学意义,两组患者均无肝静脉阻塞病和移植早期相关死亡(transplant-relate mortality,TRM)发生。MBV组、HDM组患者移植前完全缓解率均为40%,移植后完全缓解率分别提高至60%和53.33%,差异无统计学意义。移植后对两组患者进行随访,MBV组患者移植后中位随访期23.9(7.7-34.1)月,其中3例(30%)患者出现疾病进展,余7例患者均为缓解状态。随访至2017年2月28日,有1例患者死于疾病进展,余9例患者存活。HDM组患者中位随访期42.2(10.7-95.2)月,其中10例(66.67%)患者出现疾病进展,随访至2017年2月28日,8例患者移植后死亡,除1例患者死于化脓性脑膜炎,余7例均死于疾病进展。MBV组与HDM组患者2年无进展生存(progress-free survival,PFS)分别为64%和66.7%,P=0.585,2年总生存(overall survival,OS)分别为和90%和80%,P=0.708,均无统计学差异。结论:以司莫司汀、白消安和依托泊苷预处理方案行自体造血干细胞移植是治疗多发性骨髓瘤安全有效的、耐受性好的的方法,其在多发性骨髓瘤患者自体造血干细胞移植中的应用有待大样本前瞻性随机对照研究进一步证实。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.3

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