Application of bortezomib plus highdose melphalan pretreatment regimen during autologous hematopoietic stem cell transplantation for multiple myeloma
10.3760/cma.j.cn421203-20230414-00078
- VernacularTitle:硼替佐米联合大剂量美法仑预处理方案在多发性骨髓瘤自体造血干细胞移植中的应用
- Author:
Qianwen WU
1
;
Xiaolin YU
;
Xiaochen SONG
;
Lei DENG
;
Wenjun LI
;
Jing WANG
;
Yixi HOU
;
Yuerong ZHAO
;
Fang ZHOU
Author Information
1. 解放军联勤保障部队第九六〇医院血液科，济南 250031
- Keywords:
Multiple myeloma;
Hematopoietic cell transplantation;
Pretreatment;
Bortezomi
- From:
Chinese Journal of Organ Transplantation
2023;44(9):541-548
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety and efficacy of bortezomib plus highdose melphalan (L-phenylalanine nitrogen mustard) (Bor-HDM) pretreatment regimen for multiple myeloma (MM) with autologous hematopoietic stem cell transplantation (ASCT).Methods:From August 2008 to December 2021, the relevant clinical data were retrospectively reviewed for 58 MM patients undergoing MM transplantation.The conditioning regimens were Bor-HDM (n=36) and HDM (n=22). Non-hematopoietic adverse reactions, hematopoietic reconstruction time, remission rate post-ASCT and minimal negative rate of residual disease (MRD) on flow cytometry within 3 months post-ASCT and survivals were analyzed.Results:In Bor-HDM and HDM groups, median time of neutrophil engraftment was 12(8-30) and 11(8-29) day and median time of platelet reconstitution 16(8-33) and 16(7-32) day respectively.There was no significant inter-group difference ( P=0.890, P=0.638). In Bor-HDM group, the most common non-hematological adverse reactions were nausea (n=21, 58.0%) and diarrhea (n=11, 30.6%). There was no transplant-related death.Complete remission (CR) rate was (25/36, 69.4%) versus (9/22, 40.9%). The inter-group difference was statistically significant ( P=0.032). Median follow-up period was 29.0(2.0-91.0) vs. 20.5(5.0-114.0) month, 3-year progression-free survival(PFS)62.1% vs. 39.7% and 3-year overall survival(OS) 83.8% vs. 62.5%.There were relapse (n=10 vs.10) and death (n=6 vs. 7). Median PFS in Bor-HDM and HDM groups was non-attained and 27 months( P=0.047) and median OS time non-attained and 40 months respectively ( P=0.282). Multivariate analysis revealed that CR was an independent risk factor for PFS ( HR=28.896, 95% CI: 6.130-136.198, P<0.001). Non-CR was an independent risk factor for OS ( HR=3.843, 95% CI: 1.334-11.071, P=0.013; HR=28.595, 95% CI: 6.273-130.355, P<0.001). Conclusions:Bor-HDM pretreatment regimen of ASCT is both safe and efficacious for MM patients.
