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目的探讨硼替佐米(bortezomib)应用于多发性骨髓瘤(MM)患者化疗缓解或部分缓解后行自体外周血造血干细胞移植(APBSCT)的可行性和疗效。方法 8例患者根据年龄及全身状态选择采用硼替佐米联合地塞米松(VD)或硼替佐米联合吡喃阿霉素和地塞米松(VTD)方案进行移植前化疗。疗程第1、4、8、11天给予硼替佐米1.3 mg/m2静脉注射。VD或VTD方案化疗4~6个疗程后,达到完全缓解(CR)、非常好的部分缓解(VGPR)或部分缓解(PR),随后行APBSCT,采用粒细胞集落刺激因子(G-CSF)动员。预处理方案为硼替佐米+马法兰。移植后以硼替佐米+沙利度胺维持。结果所有患者在移植前均达到CR、VGPR或PR,干细胞采集充分,安全有效,移植后造血功能均快速顺利重建。移植后采用硼替佐米+沙利度胺维持,随访8~68个月,死亡2例,其余患者均无病生存。结论 VD或VTD用于MM患者的治疗达VGPR、CR或PR后,进行APBSCT可行,为MM提供了一种新的治疗方案。移植后给予硼替佐米+沙利度胺维持治疗可延长患者无病生存时间。
Objective To investigate the feasibility and efficacy of bortezomib in the treatment of patients with multiple myeloma (MM) after chemotherapy or partial remission of autologous peripheral blood stem cell transplantation (APBSCT). Methods Eight patients underwent pre-transplantation chemotherapy with bortezomib plus dexamethasone (VD) or bortezomib in combination with pirarubicin and dexamethasone (VTD) according to age and general condition. On the 1st, 4th, 8th and 11th days of treatment, bortezomib 1.3 mg / m2 was given intravenously. After complete remission (CR), very good partial response (VGPR) or partial remission (PR) after 4 or 6 cycles of chemotherapy with VD or VTD regimen, APBSCT followed by mobilization of granulocyte colony stimulating factor (G-CSF) . Pretreatment program bortezomib + melphalan. Bortezomib + thalidomide was maintained after transplantation. Results All patients achieved CR, VGPR or PR before transplantation. The stem cells were collected safely and effectively. The hematopoietic function after the transplantation was quickly and successfully reconstructed. Bortezomib + thalidomide were maintained after transplantation. The patients were followed up for 8 to 68 months and 2 died. The remaining patients were disease-free. Conclusion VD or VTD for MM patients after treatment of VGPR, CR or PR, the APBSCT feasible, provides a new treatment for MM. Bortezomib + thalidomide maintenance therapy after transplantation can prolong the patient’s disease-free survival time.