| Objective: To retrospectively analyze the clinical efficacy and related prognostic factors of PD/PCD combined with autologous hematopoietic stem cell transplantation for multiple myeloma.Methods: Retrospectively analyzed the clinical data of 13 patients with multiple myeloma(MM)who received PD/PCD combined with autologous hematopoietic stem cell transplantation(ASCT)in the Department of Hematology of Gansu Provincial People’s Hospital from 2015 to 2019,and 26 patients with pure PD/PCD linical data of MM patients with continuous PCD chemotherapy,observe and record the patient’s age,gender,disease classification and pre-transplant status,depth of disease remission and minimal residual disease(MRD),overall survival(OS)and progression-free survival(PFS),And SPSS 19 statistical analysis.Results: Among39 MM patients,13 were treated with PD/PCD combined with ASCT,7 were male(53.8%),6 were female(46.2%),and the median age was 57(42 to 70)years old.PD/PCD treatment group was 26 For example,there were 15 males(57.7%)and 11 females(42.3%),with a median age of 62(42 to 75)years.The statistical analysis of gender and age differences between the two groups was P> 0.05,and the difference was not statistically significant.13 of 39 patients underwent PD/PCD combined with ASCT,of which 8(61.5%)patients developed infection,3(23.1%)patients developed herpes zoster,and 5 patients(38.5%)developed peripheral neuropathy.Six patients(46.2%)had severe gastrointestinal reactions,and 9 patients(69.2%)had bone marrow suppression above Ⅱ degree,with no transplantrelated death.Of the 26 patients undergoing PD/PCD chemotherapy alone,18(69.2%)patients developed infections,9(34.6%)patients developed herpes zoster,13 patients(50%)developed neuropathy,and 9 patients(34.6%)The difference in adverse reactions between the two groups was P> 0.05,which was not statistically significant.13 cases of PD/PCD combined with ASCT treatment group achieved 4 cases of CR(30.8%),2 cases of VGCR(15.4%),6 cases of VGCR(46.2%),5 cases of PR(38.5%)before ASCT,and treatment of ASCT Post CR 10 cases(76.9%),VGCR 2 cases(15.4%),≥VGCR 12 cases(92.3%),PD 1 case(7.7%),before and after ASCT treatment,P <0.05,the difference was statistically significant.26 cases of PD / PCD treatment group achieved CR after treatment 9 case(34.6%),VGCR 4 cases(15.4%),≥VGCR 13 cases(50.0%),PR 7cases(26.9%),MR 2 cases(7.7%),SD 1 case(3.8%),PD 3 cases(11.5%),compared with PD/PCD combined ASCT treatment group,P <0.05,the difference was statistically significant.The median OS and PFS of patients in the PD/PCD combined ASCT group were 26(9 to 48)months and 16(3 to 42)months,respectively.However,the median OS and PFS of 26 patients in the PD/PCD treatment group were 18(5 to 38)months and 5(3 to 30)months,respectively.There was no statistically significant difference in OS stage between the PD/PCD combined ASCT group and PD / PC treatment group(P> 0.05);the PFS comparison between the two groups was statistically significant(P <0.05).13 patients with PD/PCD combined with ASCT included 2 patients ≥65 years old and 11 patients younger than 65 years old.The median PFS was 13(13 to 18)months and 16(3 to 42)months.The median OS was 19(19 to 27)months and 26(9 to 48)months.Compared with the PFS and OS of 65-year-old group and less than 65-year-old group,P was greater than 0.05,and the difference was not statistically significant.13 cases of PD/PCD combined with ASCT treatment group: 7 cases of IgG type,4 cases of IgA type,and 2 cases of free light chain type.The median PFS stage of patients with different types was 32(3 to 42)months and 18(12 to 28)Months,13(13 to 16)months,the median of OS period is 18(9 to 48)months,27(22 to 32)months,19(19 to 26)months,PFS and OS of different types In comparison,P was greater than 0.05,and the difference was not statistically significant.Of the 13 patients in the PD/PCD combined ASCT treatment group,8 were MRD positive(61.5%)before ASCT,5 were MRD negative(38.5%),3 were MRD + after ASCT(23.1%),and 10 were MRD negative(76.9%);Compared before and after transplantation,P <0.05,the difference is statistically significant.The median MRD-positive PFS before ASCT was 12(3 to18)months,and the median OS was 18(9 to 27)months;the median MRD-negative PFS before ASCT was 32(13 to 42)months,and OS was The number of digits was 35(19 to 48)months.Compared with the MRD-positive group and the MRD-negative group before ASCT,P was less than 0.05,the difference was statistically significant.Of the 13 patients in the PD/PCD combined ASCT treatment group,ISS was staged: 5 patients in stage Ⅰ(38.5%),5 patients in stage Ⅱ(38.5%),and 3 patients in stage Ⅲ(23.1%).The median PFS of different stages are 18(6 to 37)months for stage I,28(13 to 42)months for stage II,12(3 to 12)months for stage III,and 18(9 to 40)months,phase II 26(19-35)months,phase III 22(16-48)months,compared with PFS and OS in different stages,P was greater than 0.05,the difference was not statistically significant.Conclusion:1.PD/PCD combined with autologous hematopoietic stem cell transplantation still cannot reduce the toxic and side effects on the body,and its safety needs to be further studied.2.PD/PCD combined with ASCT treatment can not only improve the patient’s CR rate and VGCR rate,but also prolong the patient’s PFS.3.ASCT treatment can further improve the patient’s MRD negative conversion rate.4.Pre-ASCT MRD-negative patients can prolong PFS and OS compared to MRD-positive patients.5.If the physical condition of MM patients ≥65 years old is in good condition,there is no serious underlying disease and the adverse reactions in the treatment can be tolerated,ASCT treatment can be performed. |
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