同胞异基因外周血干细胞移植治疗多发性骨髓瘤10例疗效观察

Allogeneic peripheral blood stem cell transplantation from sibling donors for 10 patients with multiple myeloma

目的观察同胞HLA配型相合的异基因外周血干细胞移植（allo—PBSCT）治疗多发性骨髓瘤（MM）的疗效。方法10例MM患者采用氟达拉滨联合马法兰和环磷酰胺等为主的预处理方案行allo—PBSCT。其中8例患者采用环孢素加霉酚酸酯和短程甲氨蝶呤，2例采用普乐可复（FK506）加短程甲氨蝶呤预防移植物抗宿主病（GVHD）。结果所有患者造血细胞均成功植入，中性粒细胞〉0．5×10^9／L的中位时间为移植后16（12—24）d，PLT〉20×10^9／L的中位时间为移植后23（16—102）d.发生急性GVHD5例，其中仅1例发生了Ⅲ度以上急性GVHD。9例MM患者中7例发生慢性GVHD。100d内移植相关死亡1例，死因为心、肾功能衰竭和严重感染。1年预期存活率为67．5％，1年无病生存率为55．56％，复发率为11．11％。至今存活6例患者，其中1例已无病生存达99个月。结论allo—PBSCT在MM中的作用尚需进一步评估，但对于年轻有合适供者的MM患者，以氟达拉滨为基础的allo—PBSCT预处理方案，耐受性好，有可能通过降低移植相关死亡率提高总体生存率。

Objective To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation （allo-PBSCT） from sibling donors for treatment of multiple myeloma （MM）. Methods Ten patients with MM received allo-PBSCT with conditioning consisting of fludarabine plus melphalan and cyclophosphamide mostly. CsA plus mycophenolate mofetil （MMF） and short-term MTX were applied to prevent graft versus host disease （GVHD） in 8 patients, FK506 plus short-term MTX in other 2 patients. Results All patients engrafted successfully, the median time for ANC 〉 0.5×10^9/L was 16 （ 12 - 24） days, and for BPC 〉 20 ×10^9/L 23 （16 - 102）days. Five patients developed acute GVHD, and only one Ⅲ-Ⅳ aGVHD. Of 9 patients, 7 developed chronic GVHD. The transplant-related mortality （TRM） at 100 days was 10% （1/10）, mainly from heart and renal failure and severe infection. The 1-year expected overall survival （OS） , 1-year disease-free survival （DFS） and relapse rate were 67.5%, 55.56% and 11. 11% respectively. Up to now, 6 patients were still alive, of them 1 patient have survived over 99 months after allo-PBSCT. Conclusion Young MM patients having HLA-identical sibling donors well tolerated allo-PBSCT based on fludarabine to prolong their OS by reducing TRM, though further work is warranted.