Fermand J P, Chevret S, Ravaud P, Divine M, Leblond V, Dreyfus F, Mariette X, Brouet J C
Service d'Immuno-Hématologie, Hôpital Saint-Louis, Paris, France.
Blood. 1993 Oct 1;82(7):2005-9.
Sixty-three patients with high tumor mass multiple myeloma were treated with high-dose chemotherapy and total body irradiation supported by autologous blood stem cell transplantation. After high-dose therapy, they were monitored for a median of 44 months. Seven patients died early from toxicity. All the other patients, including those whose disease was resistant to previous therapies, showed a tumor mass reduction. At 6 months postengraftment, 40 (71%) of the surviving patients had minimal residual disease and 11 (20%) were in apparent complete remission. During follow-up, 25 out of the 63 (39%) patients relapsed and 16 of these died; 31 (49%) had a sustained remission. The median overall and event-free survival times after transplantation were 59 and 43 months, respectively. The initial serum beta 2-microglobulin value (> or < 2.8 mg/L) and length of previous therapy (> or < 6 courses of chemotherapy) were the only significant prognostic factors. In all surviving patients, blood stem cell autograft provided satisfactory and sustained haematopoietic reconstitution most often within 15 days. High dose chemoradiotherapy followed by autologous blood stem cell transplantation is thus an important therapeutic option for young patients with aggressive multiple myeloma.
63例高肿瘤负荷的多发性骨髓瘤患者接受了大剂量化疗及全身照射，并辅以自体血干细胞移植。大剂量治疗后，对他们进行了中位时间为44个月的监测。7例患者因毒性反应早期死亡。所有其他患者，包括那些对先前治疗耐药的患者，肿瘤负荷均有所降低。移植后6个月时，40例（71%）存活患者有微小残留病，11例（20%）达到明显完全缓解。随访期间，63例患者中有25例（39%）复发，其中16例死亡；31例（49%）持续缓解。移植后的中位总生存期和无事件生存期分别为59个月和43个月。初始血清β2微球蛋白值（>或<2.8 mg/L）和先前治疗疗程数（>或<6个化疗疗程）是仅有的显著预后因素。在所有存活患者中，自体血干细胞移植大多能在15天内提供令人满意且持续的造血重建。因此，大剂量放化疗后行自体血干细胞移植是年轻的侵袭性多发性骨髓瘤患者的重要治疗选择。
