OBJECTIVE:To investigate the application effect of sequential autologous hematopoietic stem cell transplantation (Auto-HSCT) with lenalidomide, bortezomib and dexamethasone (RVD) in the treatment of multiple myeloma (MM) evaluated by propensity score matching. METHODS:The clinical data of 49 MM patients treated with RVD scheme and followed-up for 36 months in the hospital from January 2015 to January 2021 were retrospectively analyzed and included in the control group, the clinical data of 54 MM patients who received RVD scheme and sequential Auto-HSCT scheme and completed 36 months of follow-up in the hospital during the same period were collected and included in the observation group. PSM method (1∶1, caliper value=0.01) was used to match the control group with the observation group based on baseline data and laboratory indexes, covariate equilibrium samples were obtained between groups (40 cases in each group). The clinical efficacy of patients in the two groups after 18 weeks of treatment was compared; the incidence of toxic and side effects during treatment of patients in the two groups was compared; the survival of patients in the two groups was compared after 36 months of follow-up. RESULTS:The ORR and DCR in the observation group were higher than those in the control group, the difference was statistically significant (P<0.05). Compared the incidence of fatigue, rash, thrombocytopenia, anemia and nausea of patients in the two groups, there was no statistical significant difference (P>0.05). After 36 months of follow-up (no loss during follow-up), 4 cases died from illness in the observation group, with a survival rate of 90% and an average survival time of 35.61 (95% CI: 35541-35.685) months, 10 cases died from illness in the control group, with a survival rate of 75% and an average survival time of 34.70 (95% CI: 34.559-34.832) months, the survival rate of the observation group was higher than that of the control group, the difference was statistically significant (P<0.05). CONCLUSION:Sequential Auto-HSCT with RVD regimen in the treatment of MM can improve the short-term efficacy and increase the survival rate of patients, which will not increase toxic and side effects and has high safety.

Primary granulocytic sarcoma (GS) is an uncommon, extramedullary proliferation of myeloid cells, occurring in the absence of antecedent myeloproliferative disorder. Breast involvement is uncommon. A diagnosis of GS portends a poor prognosis. Even with intensive chemotherapy for AML, progression to overt leukemia can be delayed for 2–3 years. We, report a 29-year-old man who presented with a painless, left breast lump. A modified radical mastectomy followed by histopathological and immunohistochemical testing confirmed a granulocytic sarcoma. There was no evidence of a concurrent leukemia. Intensive chemotherapy for acute myelogenous leukemia was instituted. Allogenic hematopoietic stem cell transplantation was successfully given. The patient remains in complete remission at follow-up. We highlight the importance of timely diagnosis of this uncommon entity with institution of intensive therapy. Early use of allogenic bone marrow transplantation in the treatment of primary GS may be warranted.

自体造血干细胞移植(auto-HSCT)是目前治疗恶性血液病的有效方法之一,选择恰当的预处理方案是auto-HSCT成功的关键因素之一.

Abstract Abstract 4368 Objective To investigate the effect of allogeneic transplantation in treating primary granulocytic sarcoma. Methods We report the diagnosis and treatment of one patient with primary granulocytic sarcoma and review the related articles. Results Firstly appeared as one isolated tumor in breast, the disease was diagnosed by pathological methods with immunochemistry positive stain in MPO, CD68(KP-1) and bacteriolysis enzyme. After radical operation on sick breast, the patient was treated with four courses chemotherapy according to that of acute granulocytic leukemia,then followed by matched sibling transplantation. After 6 months follow-up, the patients is still in complete remission. Conclusion If having suitable donor, patient with primary granulocytic sarcoma shoud be treated with allogeneic transplantation. Disclosures: No relevant conflicts of interest to declare.