Bishton M, Gilyead M, Das Gupta E, Williams C, Russell N H, Byrne J L
Department of Haematology, Nottingham City Hospital, Nottingham, UK.
Leuk Res. 2007 Aug;31(8):1063-8. doi: 10.1016/j.leukres.2006.12.022. Epub 2007 Feb 26.
We have used two strategies for treating myeloma patients aged 65-75 years. Those fit enough underwent Cyclophosphamide mobilisation and PBSCT using melphalan 200mg/m(2) (HDM) (n=15, median 67 years). Those less fit were mobilised with G-CSF and received melphalan 70mg/m(2) (IDM) (n=15, median 69 years). Where possible sufficient PBSC were collected so that patients not in CR after their first IDM, underwent a second IDM procedure (n=6). The treatment was well tolerated with zero day+100 TRM. Median cell dose was 4.85x10(6)CD34+cells/kg and 2.7x10(6) in the HDM and IDM groups, respectively. Neutrophil engraftment was faster in the HDM group but despite this there was a trend to earlier discharge in the IDM group (13 days versus 15 days) and lower antibiotic and anti-fungal usage, suggesting better tolerability. Response rates were similar with CRs achieved in 7/15 patients receiving HDM and 9/15 receiving IDM (6 after the first and 3 after the second procedure). Three patients did not undergo a second IDM due to insufficient cells. In the IDM group 11/15 remain alive at a median follow up of 14 months with 5 in CR, whilst in the HDM group 12/15 are alive with 5 in CR at a median follow up of 15.5m. We conclude both approaches have comparable efficacy but that IDM may be better tolerated in an older age group.
我们采用了两种策略来治疗65至75岁的骨髓瘤患者。身体状况较好的患者接受环磷酰胺动员，并使用200mg/m²的美法仑进行自体造血干细胞移植（HDM）（n = 15，中位年龄67岁）。身体状况较差的患者使用粒细胞集落刺激因子进行动员，并接受70mg/m²的美法仑（IDM）（n = 15，中位年龄69岁）。在可能的情况下，收集了足够的外周血干细胞，以便首次IDM后未达到完全缓解的患者接受第二次IDM治疗（n = 6）。治疗耐受性良好，移植相关死亡率为零。中位细胞剂量在HDM组和IDM组分别为4.85×10⁶个CD34⁺细胞/kg和2.7×10⁶个。HDM组中性粒细胞植入更快，但尽管如此，IDM组有更早出院的趋势（13天对15天），且抗生素和抗真菌药物的使用量更低，提示耐受性更好。缓解率相似，接受HDM的15例患者中有7例达到完全缓解，接受IDM的15例患者中有9例达到完全缓解（第一次治疗后6例，第二次治疗后3例）。3例患者因细胞数量不足未接受第二次IDM治疗。在IDM组，15例中有11例在中位随访14个月时仍存活，其中5例达到完全缓解；而在HDM组，15例中有12例在中位随访15.5个月时存活，其中5例达到完全缓解。我们得出结论，两种方法疗效相当，但IDM在老年人群中耐受性可能更好。
