Analysis Of The Efficacy Of BD Induction Regimen Prior To Autologous Hematopoietic Stem Cell Transplantation And Bortezomib Maintenance Treatment In Multiple Myeloma

BackgroundMultiple myeloma(MM)is a hematopoietic malignancy with abnormal proliferation of plasma cells.It has been recognized as an incurable disease for many years.Autologous hematopoietic stem cell transplantation(auto-HSCT)is an important means of treating multiple myeloma,Sequential autologous hematopoietic stem cell transplantation after induction chemotherapy has gradually become the first-line treatment for multiple myeloma.Maintenance therapy after transplantation is of great significance for further improving the efficacy and prognosis of patients with multiple myeloma.How to optimize the maintenance therapy after transplantation,so as to achieve better curative effect and improve the prognosis of MM is the key topic of current research.ObjectivesTo observe the therapeutic effect and prognosis of multiple myeloma(MM)patients treated with the BD(bortezomib+dexamethasone)regimen prior to autologous hematopoietic stem cell transplantation(auto-HSCT).To evaluate the prognosis and safety of bortezomib in maintenance therapy after autologous transplantation.MethodsWe retrospectively analyzed the clinical data of 38 MM patients receiving BD regimen prior to auto-HSCT and maintenance treatment at the hematopoietic stem cell transplantation center of the first affiliated hospital of Zhengzhou University from January 2011 to August 2017.All patients receiving BD regimen prior to auto-HSCT.Application of large dose of cyclophosphamide(CTX)3 g/m~2+recombinant human granulocyte colony stimulating factor(rhG-CSF)5~7.5ug/(kg·d)mobilization plan,application"high-dose melphapan"scheme for pretreatment before transplantation.All patients received maintenance therapy after transplantation,among which 22 patients received maintenance therapy with"bortezomib+thalidomide"and 16 patients received maintenance therapy with thalidomide.Comparing complete remission(CR)rates before and after transplantation.Analysing the overall survival rate(OS)and progression free survival(PFS).Comparing the OS and PFS between the"bortezomib+thalidomide"maintenance treatment group and the thalidomide maintenance treatment group.Results:After induction treatment of BD regimen,complete remission(CR)rate was28.9%and?very good partial remission(VGPR)rate was 60.5%of the all patients.After auto-HSCT,CR rate was 52.6%and?VGPR rate was 81.5%of the all patients.CR rate was significantly increased after auto-HSCT:which was 52.6%vs28.9%(P=0.031).?VGPR rates was significantly increased after auto-HSCT:which was 81.5%vs 60.5%(P=0.038).The median follow-up time for 38 MM patients was 21 months(9~64 months),the overall survival(OS)rate was 67.4%,the progression-free survival(PFS)rate was54.3%,respectively.22 patients received“bortezomib_+thalidomide”maintenance treatment after auto-HSCT whereas 16 received thalidomide maintenance treatment.The 3-year PFS rate of“bortezomib_+thalidomide”maintenance treatment group was significantly higher than that of thalidomide group:57.5%vs 49.4%(P=0.047).There was no significant difference in 3-year OS rate between the“bortezomib+thalidomide”maintenance treatment group and the thalidomide maintenance treatment group:80.0%vs.61.3%(P=0.335).There was no statistically significant difference in the incidence of adverse reactions between the"bortezomib+thalidomide"maintenance group and the thalidomide maintenance group after transplantation.ConclusionBD induction regimen prior to auto-HSCT can improve the complete remission rate and?very good partial remission rate,which is an effective treatment for MM patients.After auto-HSCT,bortezomib+thalidomide maintenance treatment could further extend the PFS for MM patients and application process was safety.