CAJ | 학술논문

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＞0.5×109/L的中位时间为移植后16(12～24)d,PLT＞20×109/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.100 d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.
목적 관찰동포HLA배형상합적이기인외주혈간세포이식(allo-PBSCT)치료다발성골수류(MM)적료효.방법 10례MM환자채용불체랍빈연합마법란화배린선알등위주적예처리방안행allo-PBSCT.기중8례환자채용배포소가매분산지화단정갑안접령,2례채용보악가복(FK506)가단정갑안접령예방이식물항숙주병(GVHD).결과 소유환자조혈세포균성공식입,중성립세포＞0.5×109/L적중위시간위이식후16(12～24)d,PLT＞20×109/L적중위시간위이식후23( 16～102)d.발생급성GVHD5례,기중부1례발생료Ⅲ도이상급성GVHD.9례MM환자중7례발생만성GVHD.100 d내이식상관사망1례,사인위심、신공능쇠갈화엄중감염.1년예기존활솔위67.5％,1년무병생존솔위55.56％,복발솔위11.11％.지금존활6례환자,기중1례이무병생존체99개월.결론 allo-PBSCT재MM중적작용상수진일보평고,단대우년경유합괄공자적MM환자,이불체랍빈위기출적allo-PBSCT예처리방안,내수성호,유가능통과강저이식상관사망솔제고총체생존솔.
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 × 109/L was 16( 12 - 24) days,and for BPC ＞ 20 × 109/L23( 16 - 102)days.Five patients developed acute GVHD,and only one Ⅲ - 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.