Clinical observation of busulfan,cyclophosphamide and etoposide as the conditioning in 22 patients with multiple myeloma treated by autologous hematopoietic stem cell transplantation
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摘要: 目的:分析预处理方案BCV(白消安+环磷酰胺+依托泊苷)在自体造血干细胞移植(ASCT)治疗多发性骨髓瘤(MM)患者中的安全性及疗效。方法:回顾性分析22例MM患者采用环磷酰胺(3 g/m2)加粒细胞集落刺激因子动员造血干细胞后采用BCV方案预处理进行ASCT,了解患者造血重建情况、移植相关并发症的发生情况以及疗效评估,评价该预处理方案的安全性及效果。结果:22例患者中位年龄52(32~66)岁,移植前病情评估至少达部分缓解,经ASCT后均获得造血重建,中性粒细胞植入中位时间为10.5(5~19) d,血小板植入中位时间为10(7~20) d。主要的非血液学不良反应是黏膜炎和消化道不良反应。1例患者粒细胞缺乏期出现大肠杆菌败血症,5例患者出现肺部感染,其中1例肺部真菌感染,4例患者出现出血性膀胱炎,3例患者出现肝脏毒性(转氨酶1~2级升高),2例患者出现肾脏毒性,1例患者出现幻觉,3例患者出现心血管毒性。中位随访12(4~28)个月,移植后1年的无进展生存率为76.6%(标准误为10.3%),移植相关死亡率为0。截止随访日期,其中1例患者由于疾病进展、并失去最佳治疗后死亡,其余患者均存活。结论:BCV方案作为MM患者ASCT的预处理方案具有可控的安全性,治疗反应理想,长期疗效尚需观察。Abstract: Objective:To analyze the safety and efficacy of autologous stem cell transplantation(ASCT) with BCV(busulfan + cyclophosphamide + etoposide) conditioning regimen in the treatment of multiple myeloma(MM).Method:We retrospectively analyzed the use of BCV as a conditioning regimen for ASCT in 22 patients diagnosed with MM.They mobilized hematopoietic stem cells with cyclophosphamide(3 g/m2) and G-CSF,and then used BCV as a conditioning regimen for ASCT.We analyzed the hematopoietic reconstitution and complications related to transplantation,and to evaluate the safety and effectiveness of the conditioning regimen.Result:The median age of 22 patients was 52(32-66) years.Pre-transplantation condition was assessed to be at least part remission.After ASCT,hematopoietic reconstitution was achieved.The median times to neutrophil and platelet engraftment were was 10.5(5-19) days and 10(7-20) days.The main toxicity was mucositis and adverse gastrointestinal reactions.One patient developed septicemia of Escherichia coli during Neutropenic,and 5 patients developed pulmonary infection.One patient had pulmonary fungal infection,4 patients had hemorrhagic cystitis,3 patients had hepatic toxicity(elevated transaminase 1-2 grade),2 patients had renal toxicity,1 patient had hallucination and 3 patients had cardiovascular toxicity.Median follow-up for the group was 12(4-28) months.The progression-free survival at 12 months was 76.6%(standard error was 10.3%) and there was no early treatment-related mortality.At the end of follow-up,one patient died due to disease progression and loss of optimal treatment,and the rest survived.Conclusion:BCV as conditioning regimen for ASCT of MM patients has controllable safety,ideal therapeutic response and long-term efficacy needs to be observed.
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