Chen Kaili, Liang Huixin, Yu Zezhong, Guo Guangyao, Zheng Huijian, Huang Yun, Liu Liping, Lin Jie, Long Jinlan, Pan Renyao, Chen Xi, Wang Changgui, Zhang Wenjie, Xu Zhenshu
Department of Blood Transfusion, Affiliated Hospital of Putian University, Putian, 351100, China.
Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, 29 Xinquan Rd, Fuzhou, 350001, China.
Sci Rep. 2025 Jan 7;15(1):1222. doi: 10.1038/s41598-024-84047-2.
This retrospective study aimed to stress the advantages of autologous hematopoietic stem cell transplantation (auto-HSCT) in treating primary MM. Ninety-four MM patients who underwent initial parallel sequential auto-HSCT were selected. Data on efficacy (efficacy evaluation, renal function and hemoglobin recovery), immune reconstitution (B-cell subsets, immunoglobulin levels, T-cell subsets, NK cells, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR)) and hematopoietic reconstitution times were collected and analyzed. Whether in all selected patients or in groups R-ISS II-III, there was a notable increase in the proportion of patients achieving in a very good partial response (VGPR) or better (P < 0.001, P = 0.02) and a complete response (CR) or better (P = 0.007, P = 0.014) after transplantation compared to the pre-transplant status. Post-Transplant Immune Reconstitution Analysis (Baseline vs. Pre-Transplant and Pre-Transplant vs. Post-Transplant): The level of CD19 + B cells, CD20 + B cells, CD22 + B cells, CD3 + T cells, IgG and LMR showed the same change trend, that is, it decreased before transplantation (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P<0.007, P < 0.001) and then increased significantly after transplantation(P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001). CD3 + CD4 + T cells from 545.97 (342.11,708.60)/µL to 342.93 (168.38, 475.52)/µL (P < 0.001) and then to 251.48 (188.52, 406.98)/µL (P = 0.348); CD3 + CD8 + T cells from 391.36 (242.19, 563.37)/µL to 337.23 (192.54, 505.96)/µL (P = 0.065) and then to 797.96 (514.49, 1198.03)/µL (P < 0.001), so the CD3 + CD4+/CD3 + CD8 + T cell ratio still remained inverted post-transplant. NK cells changed from 309.86 (206.33, 460.96)/µL to 258.31 (160.75, 436.68)/ µL (P = 0.229) and then to 151.08 (108.17, 240.84)/µL (P = 0.007). Auto-HSCT can promote prolonged remission in patients with MM and also overcome some high-risk factors to achieve superior efficacy in group R-ISS II-III. Patients were immunodeficient before transplantation and auto-HSCT facilitated immune reconstitution.
这项回顾性研究旨在强调自体造血干细胞移植（auto-HSCT）在治疗原发性多发性骨髓瘤（MM）中的优势。选取了94例行初始平行序贯auto-HSCT的MM患者。收集并分析了疗效（疗效评估、肾功能和血红蛋白恢复情况）、免疫重建（B细胞亚群、免疫球蛋白水平、T细胞亚群、自然杀伤细胞、中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR））以及造血重建时间的数据。无论是在所有入选患者中还是在R-ISS II-III组中，与移植前状态相比，移植后达到非常好的部分缓解（VGPR）或更好缓解的患者比例显著增加（P＜0.001，P = 0.02），达到完全缓解（CR）或更好缓解的患者比例也显著增加（P = 0.007，P = 0.014）。移植后免疫重建分析（基线与移植前及移植前与移植后）：CD19⁺B细胞、CD20⁺B细胞、CD22⁺B细胞、CD3⁺T细胞、IgG和LMR水平呈现相同变化趋势，即移植前下降（P＜0.001，P＜0.001，P＜0.001，P＜0.001，P＜0.007，P＜0.001），移植后显著升高（P＜0.001，P＜0.001，P＜0.001，P＜0.001，P＜0.001，P＜0.001）。CD3⁺CD4⁺T细胞从545.97（342.11，708.60）/μL降至342.93（168.38，475.52）/μL（P＜0.001），然后降至251.48（188.52，406.98）/μL（P = 0.348）；CD3⁺CD8⁺T细胞从391.36（242.19，563.37）/μL降至337.23（192.54，505.96）/μL（P = 0.065），然后升至797.96（514.49，1198.03）/μL（P＜0.001），所以移植后CD3⁺CD4⁺/CD3⁺CD8⁺T细胞比值仍保持倒置。自然杀伤细胞从309.86（206.33，460.96）/μL降至258.31（160.75，436.68）/μL（P = 0.229），然后降至151.08（108.17，240.84）/μL（P = 0.007）。Auto-HSCT可促进MM患者长期缓解，还能克服一些高危因素，在R-ISS II-III组中取得更好疗效。患者移植前存在免疫缺陷，auto-HSCT有助于免疫重建。
