| Objective:Autologous peripheral blood stem cell transplantation(APBSCT)is currently one of the main methods for the treatment of multiple myeloma(MM).Preconditioning is a key link in autologous hematopoietic stem cell transplantation.Choosing an efficient and low-toxic pretreatment regimen can effectively improve the efficacy of MM.The purpose of this study was to compare the efficacy and survival of secondary autologous peripheral blood stem cell transplantation and single autologous peripheral blood stem cell transplantation in the treatment of MM under HD-Mel(High dose Melphalan)+PD(Bortezomib,Dexamethasome)pretreatment regimen.Methods:From January 2017 to October 2022,22 patients with multiple myeloma who underwent autologous peripheral blood stem cell transplantation in Cangzhou People’s Hospital were screened and signed informed consent.They were divided into secondary transplantation group(ASCT-2,n=11)and single transplantation group(ASCT-1,n=11).All 22 patients were treated with HD-Mel+PD regimen as pretreatment,melphalan 200mg/m~2(d-2Q6h,d-1oral),bortezomib 1mg/m~2(d-6,d-3,d2 subcutaneous injection),dexamethasone20mg(d-6,d-3,d2 static point),of which ASCT-2 group of patients in the second autologous peripheral blood stem cell transplantation to reduce the dose of melphalan in the pretreatment regimen(melphalan 140mg/m~2).After the transfusion,the general condition of the patients in the transplantation warehouse was monitored,the platelet and white blood cell engraftment time were recorded,and the patients were followed up regularly to monitor the efficacyandsurvival.Theage,gender,type,stage,IMWGrisk stratification,number of stem cell collection,implantation time,pre-transplantationstatus,complicationsafterpretreatment,and post-transplantation efficacy of the two groups were analyzed by SPSS 26.0software.The survival curve was drawn by Graphpad Prism 9.0 software,and the survival curve was analyzed by log.rank test.Statistically significant difference was defined as P<0.05.Results:1.The average age of patients in ASCT-2 group was 55.09±11.35 years old,and the average age of patients in ASCT-1 group was 54.82±5.46 years old.There were 7 males and 4 females in both groups.There was no significant difference in age and gender between the two groups(P>0.05).In ASCT-2 group,there were 1 case of Ig A-κtype,4 cases of Ig G-κtype,2 cases of Ig G-λtype,3 cases of light chainκtype and 1 case of light chainλtype.In the ASCT-1 group,there were 1 case of Ig A-κtype,3 cases of Ig G-κtype,3cases of Ig G-λtype,3 cases of light chainκtype and 1 case of light chainλtype.The difference between the two groups was statistically analyzed,P>0.05,the difference was not statistically significant.In the ASCT-2 group,DS stage:IA stage 1 case,IIA stage 2 cases,IIIA stage 7 cases,IIIB stage 1 case;ISS staging:3 cases of stage I,5 cases of stage II,3 cases of stage III;in the ASCT-1 group,DS stage:9 cases of stage IIIA,2 cases of stage IIIB;ISS stage:1 case of stage I,3 cases of stage II,7 cases of stage III.There was no significant difference in DS staging and ISS staging between the two groups(P>0.05).IMWG risk stratification:2 cases of low risk,4 cases of standard risk and 5 cases of high risk in ASCT-2 group;in ASCT-1 group,there were 0cases of low risk,8 cases of standard risk and 3 cases of high risk.There was no significant difference in IMWG risk stratification between the two groups(P>0.05).2.Among the 22 patients with multiple bone marrow who underwent autologous peripheral blood stem cell transplantation,both ASCT-2 group and ASCT-1 group achieved hematopoietic reconstruction after autologous stem cell reinfusion,and all of them were successfully implanted.The average time of platelet implantation(>20×10~9/L)in ASCT-2 group was14.45±1.67 days,and the average time of neutrophil implantation(>0.5×10~9/L)was 13.45±3.17 days.The average time of platelet implantation(>20×10~9/L)in ASCT-1 group was 13.73±4.00 days,and the average time of neutrophil implantation(>0.5×10~9/L)was 11.91±2.61 days;the platelet and neutrophil implantation time of the two groups were statistically analyzed.The data of the two groups were homogeneous,P>0.05,and the difference was not statistically significant.3.At the beginning of the application of HD-Mel+PD pretreatment regimen,the patient will enter the bone marrow suppression period,and the complications that occur during this period will be sorted out:the most common complications are electrolyte metabolism disorders,upper respiratory tract infections and pulmonary infections.One patient had IV degree adverse reactions,and the other patients had adverse reactions between 0 and II degrees.For different doses of melphalan(200mg/m~2vs.140mg/m~2)combined with bortezomib and dexamethasone pretreatment regimen for all patients and ASCT-2 group for the first and second transplantation complications were statistically analyzed P>0.05,the difference was not statistically significant.4.In ASCT-2 group,there were 4 cases of PR,3 cases of VGPR and 4cases of CR before transplantation.There were 4 cases of PR,5 cases of VGPR and 2 cases of CR in ASCT-1 before transplantation.There was no significant difference in the pre-transplant status between the two groups(P>0.05).5.All 22 patients underwent a comprehensive evaluation within 1 to 4months after transplantation.In the ASCT-2 group,5 patients achieved CR,2patients achieved VGPR,1 patient achieved PR,2 patients had disease progression,and 1 patient relapsed after CR.In ASCT-1,6 patients achieved CR,3 patients achieved VGPR,1 patient achieved PR,and 1 patient had successful hematopoietic stem cell transplantation,but severe pulmonary infection occurred and died during follow-up.The efficacy of ASCT-2 group and ASCT-1 group after transplantation was statistically analyzed,P>0.05,the difference was not statistically significant.6.In terms of survival,the difference in PFS between the ASCT-2 group and the ASCT-1 group was statistically analyzed P>0.05,while the ASCT-2group was compared with the ASCT-1 group in PFS and OS.Statistical analysis showed that HR was less than 1.Conclusions:1.The patients with multiple myeloma treated with autologous peripheral blood stem cell transplantation under HD-Mel+PD pretreatment regimen were well tolerated and their hematopoietic function recovered well.However,more cases need to be included in the study to further explore the safety of the pretreatment regimen.2.There was no significant difference in response depth between secondary transplantation and primary transplantation under HD-Mel+PD pretreatment regimen.At the end of the follow-up,although there was no significant difference in PFS and OS between the ASCT-2 group and the ASCT-1 group,the HR of the ASCT-2 group in PFS and OS was less than1,indicating that the ASCT-2 group had a better survival trend in PFS and OS.Due to the small number of cases,short follow-up time,different types and quantities of cytogenetic abnormalities,treatment methods for EMD(whether surgical resection),and cytogenetic abnormalities in patients with EMD,more cases need to be included in the follow-up to further more accurate stratification to obtain more accurate results. |
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