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目的:分析含硼替佐米诱导治疗序贯自体造血干细胞移植(ASCT)的治疗方案对初诊时合并髓外病变(EMD)的多发性骨髓瘤(MM)患者预后的影响。方法:回顾性分析244例初诊MM患者的临床资料,主要研究终点为总生存(OS)和无进展生存(PFS)。结果:入选的244例初诊患者中合并EMD者66例(27.0%)。244例患者按治疗方案分为3组:传统化疗组59例,持续新药治疗组87例,新药序贯ASCT组98例。传统化疗组中伴有EMD患者的中位PFS显著低于不伴EMD患者(7.433∶25.400个月,P=0.024),持续新药治疗组中伴有EMD患者的中位PFS与不伴EMD患者比较,差异无统计学意义(15.133∶27.100个月,P=0.269),硼替佐米序贯ASCT组中伴有EMD患者的中位PFS与不伴EMD患者比较,差异亦无统计学意义(46.667∶44.867个月,P=0.743)。在EMD患者中,硼替佐米序贯ASCT组与传统化疗组及持续新药治疗组相比,均可显著提高患者的中位PFS(P<0.05)。传统化疗组中伴有EMD患者的中位OS显著低于不伴EMD患者(21.033∶34.667个月,P=0.043),持续新药治疗组中伴有EMD患者的中位OS显著低于不伴EMD患者(10.400∶44.300个月,P=0.004),而在硼替佐米序贯ASCT组中伴有EMD与不伴EMD患者间OS比较,差异无统计学意义(P=0.325)。在EMD患者中,硼替佐米序贯ASCT组与传统化疗组及持续新药治疗组相比,均可显著提高患者的中位OS(P<0.005)。结论:含硼替佐米诱导治疗序贯ASCT的治疗方案可显著提高初诊伴EMD的MM患者的生存,克服EMD的不良预后影响。
Objective: To analyze the effect of bortezomib-induced sequential autologous hematopoietic stem cell transplantation (ASCT) on the prognosis of multiple myeloma (MM) patients with extramedullary lesions (EMD) at the time of initial diagnosis. Methods: The clinical data of 244 newly diagnosed MM patients were retrospectively analyzed. The main study endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS: Of the 244 newly diagnosed patients enrolled, 66 (27.0%) had EMD. 244 patients were divided into 3 groups according to the treatment plan: 59 cases in the traditional chemotherapy group, 87 cases in the continuous new drug treatment group, and 98 cases in the new drug sequential ASCT group. The median PFS in patients with EMD in the conventional chemotherapy group was significantly lower than that in patients without EMD (7.433:25.400 months, P=0.024). The median PFS in patients with persistent EMT was compared with those without EMD. The difference was not statistically significant (15.133:27.100 months, P=0.269). There was no significant difference in the median PFS in patients with EMD in the bortezomib sequential ASCT group compared with those without EMD (46.667: 44.867 months, P=0.743). In patients with EMD, bortezomib sequential ASCT group can significantly increase the median PFS in patients compared with traditional chemotherapy group and continuous new drug treatment group (P<0.05). The median OS in patients with EMD in the conventional chemotherapy group was significantly lower than that in patients without EMD (21.033:34.667 months, P = 0.043). The median OS of patients with EMD in the continuous new drug treatment group was significantly lower than that without EMD. Patients (10.400: 44.300 months, P=0.004), but there was no significant difference in OS between patients with EMT and without EMD in bortezomib sequential ASCT group (P=0.325). In patients with EMD, the bortezomib sequential ASCT group significantly improved the patients’ median OS compared with the conventional chemotherapy group and the continuous new drug treatment group (P<0.005). CONCLUSION: The treatment regimen of sequential administration of bortezomib-induced sequential ASCT can significantly improve the survival of newly diagnosed MM patients with EMD and overcome the adverse prognosis of EMD.