CAJ | 학술논문

目的评价BCV(白消安+环磷酰胺+足叶乙甙)预处理方案在多发性骨髓瘤(MM)自体造血干细胞移植(ASCT)患者的疗效和安全性.方法 2007年9月至2010年9月采用大剂量马法兰对32例MM患者行ASCT预处理(HDM组),中位年龄53.5(30 ～63)岁；2010年10月至2012年10月采用BCV方案(白消安静脉给药、总剂量9.6 mg/kg)对38例MM患者行ASCT预处理(BCV组),中位年龄54(35 ～64)岁.结果两组患者MM分型、Durie-Salmon分期、国际分期体系(ISS)分期及接受一、二、三线以上治疗患者比例差异均无统计学意义.BCV组与HDM组比较,中性粒细胞植入时间[10.5(9～15)d对11(9～27) d,P =0.057]和血小板植入时间[11(9～210)d对12(10～45),P=0.100],差异均无统计学意义.两组患者预处理不良反应相似,无肝静脉阻塞病和移植早期死亡发生.BCV组、HDM组患者ASCT后完全缓解率(分别为63.18％、59.38％)均高于ASCT前(分别为44.74％、37.50％).BCV组中位随访16(2～ 27)个月,10例(26.32％)患者出现疾病进展,1年无进展生存率为71.37％.结论含减低剂量白消安针剂的BCV方案对于MM患者是安全、有效的ASCT预处理方案,其远期疗效尚待长期随访观察.
목적 평개BCV(백소안+배린선알+족협을대)예처리방안재다발성골수류(MM)자체조혈간세포이식(ASCT)환자적료효화안전성.방법 2007년9월지2010년9월채용대제량마법란대32례MM환자행ASCT예처리(HDM조),중위년령53.5(30 ～63)세；2010년10월지2012년10월채용BCV방안(백소안정맥급약、총제량9.6 mg/kg)대38례MM환자행ASCT예처리(BCV조),중위년령54(35 ～64)세.결과 량조환자MM분형、Durie-Salmon분기、국제분기체계(ISS)분기급접수일、이、삼선이상치료환자비례차이균무통계학의의.BCV조여HDM조비교,중성립세포식입시간[10.5(9～15)d대11(9～27) d,P =0.057]화혈소판식입시간[11(9～210)d대12(10～45),P=0.100],차이균무통계학의의.량조환자예처리불량반응상사,무간정맥조새병화이식조기사망발생.BCV조、HDM조환자ASCT후완전완해솔(분별위63.18％、59.38％)균고우ASCT전(분별위44.74％、37.50％).BCV조중위수방16(2～ 27)개월,10례(26.32％)환자출현질병진전,1년무진전생존솔위71.37％.결론 함감저제량백소안침제적BCV방안대우MM환자시안전、유효적ASCT예처리방안,기원기료효상대장기수방관찰.
Objective To evaluate the efficacy and safety of dose-reduced intravenous busulfan,cyclophosphamide and etoposide (BCV) as conditioning for autologous stem cell transplantation (ASCT) in multiple myeloma (MM).Methods From September 2007 to September 2010,thirty-two ASCT-eligible patients with MM received high dose melphalan (HDM) as conditioning in our center.Median age was 53.5 (30-63) years.From October 2010 to October 2012,thirty-eight patients conditioned by BCV regimen (intravenous busulfan,total doses 9.6 mg/kg),whose median age was 54 (35-64) years.Results There were no statistical differences in clinical characteristics between the two groups,including myeloma isotype,Durie-Salmon staging,international staging system(ISS),and patients received the first line,second line or more than third line therapy.The median time to neutrophil and platelet engraftment were 10.5 vs 11 days (P =0.057) and 11 vs 12 days (P =0.100) in the BCV and HDM groups,respectively.The toxicity of two conditioning regimens had no significant difference.None of hepatic veno-occlusive disease and early transplant related mortality was observed.Although overall response rates showed no significant difference between two groups (P ＞ 0.05),the CR rates increased from 44.74％ pre-ASCT to 63.18％ post-ASCT in the BCV group,while 37.50％ to 59.38％ in the HDM group.During the median follow-up of 16 months (range 2-27) in BCV group,ten patients (26.32％) developed progressive disease and PFS at 12 months were 71.37％.Conclusions In this study,the dose-reduced intravenous busulfan,cyclophosphamide and etoposide (BCV) conditioning was demonstrated an effective and safety regimen for ASCT-eligible patients with MM.However,the long term observation is needed.