The Value Of Autologous Hematopoietic Stell Cell Transplantation In The Treatment Of Multiple Myeloma In The New Drug Era

Objective: To evaluate the efficacy and prognosis of autologous peripheral hematopoietic stem cell transplantation in the treatment of multiple myeloma in the new drug era.Methods: 1.A retrospective analysis of 48 patients who were hospitalized in lanzhou university second hospital from November 2011 to April 2017 with a diagnosis of MM,in which 17 patients with APBSCT treated as experimental group(transplantation group),and 31 cases of patients who were not treated with APBSCT as the control group(non-transplant group).The 17 cases patients with APBSCT(15 cases with bortezomib)before transplantation in 3~6 cycles of induction therapy.cyclophosphamide(3g/m2,d1-2)combined G-CSF mobilization of stem cells,and choose to high-dose melphalan(200 mg/m2)as pretreatment scheme of transplantation,d0 day back to infusion.Post-transplantation with thalidomide-alone or(thalidomide + bortezomib)or lenalidomide –alone for maintenance therapy.In 31 cases of non-transplant control group,the patients were treated with combined chemotherapy with bortezomib for more than 4 courses,and the maintenance treatment was the same regimen as the transplantation group.2.APBSCT was evaluated for its efficacy,minimal residual disease(MRD),overall survival(OS),and progression free survival(PFS).Results:1.Among the 17 patients in the transplantation group,CR 7 cases(41.2%),VGPR 3(17.6%),and PR 7(41.2%)were obtained.After transplantation,CR 13 cases(76.5%),4 cases of VGPR(23.5%),and PR 0(0%).,the remission rate was significantly improved after transplantation,and P=0.037.there were10 patients(32.3%)achieved CR in non-transplantation group,and the CR rate of transplantation group was significantly higher than that of non-transplantation group(P=0.003).The CR rate of transplantation group was significantly higher than that of non-transplantation(P=0.003).2.In transplantation group,before transplantation,MRD-7cases(41.2%),MRD+10 cases(58.8%);After transplantation,MRD-13 cases(76.5%),MRD+4 cases(23.5%);After the combined chemotherapy for 8 courses of non-transplantation group,MRD-2 cases(16.7%),MRD+10 cases(83.3%),and the MRD-rate of transplantation group were significantly improved than that of the non-transplantation group,P=0.001,and the difference was statistically significant.The MRD-rate was significantly improved after transplantation,P=0.037,and the difference was statistically significant.3.In the transplantation group,all the 17 cases patients acquired hematopoietic reconstruction after transplantation.Transplant-related complications mainly include low cell period of fever,the infection of respiratory tract,intestinal and skin mucous membrane,all patients had gastrointestinal reactions for instance nausea and vomiting,hiccups and diarrhea,at last,no body died from transplantation.Up to the follow-up time,among the 17 cases APBSCT patients,there are 3 cases died(17.6%)patients,All the remaining 14 cases survived,and the disease was stable,and no recurrence or progression of the disease occurred.In the non-transplantation group,13 of whom had relapse and 4 died.4.With a 36-month median follow-up time.and the median overall survival and progression free survival of the 17 patients were 36(11 ~ 76)months and 24(11 ~ 76)months respectively.However,The median OS and PFS were 19(3 ~ 38)months and 11(3 ~ 37)months in 31 patients with non-transplantation control group.The OS comparison between the two groups,P=0.231,was not statistically significant;PFS comparison between the two groups,P=0.006,was statistically significant.Among the 29 patients with MRD detection in the transplantation group and the non-transplantation group,MRD-15(51.7%),MRD+14(48.3%),MRD-and MRD+ were compared between the two groups,P=0.103,and the difference was not statistically significant.PFS comparison,P=0.044,the difference was statistically significant.Conclusion: 1.The autologous hematopoietic stem cell transplantation in the age of new drug can significantly improve the remission rate,alleviate the depth,lengthen the time of progression free survival,and have the irreplaceable status,is the best standard treatment for young,eligible transplantation MM patients.2.The MRD negative detection rate was higher after transplantation,and patients whose minimal residual disease(MRD)are negative,have better PFS than the positive ones.3.For patients with high risk of ISS staging,autologous hematopoietic stem cell transplantation should be performed as soon as possible.