CAJ | 학술논문

目的了解早期进行同胞及非亲缘异基因造血干细胞移植治疗45岁以下多发性骨髓(MM)的疗效及不良反应.方法 3例38～44岁的MM患者,在两疗程化疗达到缓解后,早期进行HLA相合异基因血干细胞移植,其中例1、2为同胞供者,例3为非亲缘供者.例1、2预处理方案采用氟达拉滨、白消安联合环磷酰胺,预防移植物抗宿主病(GVHD)采用甲氨蝶呤联合环孢素A.例3预处理方案采用改良白消安、环磷酰胺联合抗胸腺细胞免疫球蛋白,预防GVHD采用吗替麦考酚酯、甲氨蝶呤联合环孢素A.结果 3例患者均移植成功,例1出现Ⅱ度急性GVHD及广泛型慢性GVHD,例2、3均未出现GVHD,至今随诊时间为48、27、6个月,3例均至今均生存,无疾病复发迹象.结论对45岁以下的MM患者,化疗缓解后,早期进行HLA相合的同胞及非亲缘异基因造血干细胞移植治疗,移植相关死亡率较低,完全缓解率高.有可能长期生存.
목적 료해조기진행동포급비친연이기인조혈간세포이식치료45세이하다발성골수(MM)적료효급불량반응.방법 3례38～44세적MM환자,재량료정화료체도완해후,조기진행HLA상합이기인혈간세포이식,기중례1、2위동포공자,례3위비친연공자.례1、2예처리방안채용불체랍빈、백소안연합배린선알,예방이식물항숙주병(GVHD)채용갑안접령연합배포소A.례3예처리방안채용개량백소안、배린선알연합항흉선세포면역구단백,예방GVHD채용마체맥고분지、갑안접령연합배포소A.결과 3례환자균이식성공,례1출현Ⅱ도급성GVHD급엄범형만성GVHD,례2、3균미출현GVHD,지금수진시간위48、27、6개월,3례균지금균생존,무질병복발적상.결론 대45세이하적MM환자,화료완해후,조기진행HLA상합적동포급비친연이기인조혈간세포이식치료,이식상관사망솔교저,완전완해솔고.유가능장기생존.
Objective To evaluate the effectiveness and side effects in sibling and unrelated HLA identical allogeneic hematopoietic stem cell transplantation for multiple myeloma patients under 45-year-old at early stage. Methods Three patients with multiple myeloma ranged from 38 to 44-year-old received two courses of chemotherapies and achieved partial remission. Sibling HLA identical allogeneic hematopoietic stem cell transplantations were underwent in case 1 and 2, and unrelated were in case 3. The conditioning regimens for case 1 and 2 included fludarabine, busulfan plus cyclophosphamide, and of case 3 included modified busulfan, cyclophosphamide plus antithymocyte globulin. Cycloporine A combined with methotrexate were used to prevent GVHD in the case 1 and 2, and methotrexate, mycophenolate and cycloporine A were used in case 3. Results All patients achieved full donor chimerism without graft failure. Grade Ⅱ acute GVHD and extensive chronic GVHD were found in case 1, but not in case 2 and 3. The period of follow-up of case 1, 2 and 3 were 48, 27 and 6 months, respectively, and all of them were alive with no signs of relapse. Conclusion The multiple myeloma patients under 45-year-old underwent sibling and unrelated HLA identical allogeneic hematopoietic stem cell transplantation at early stage after chemotherapy remission have the low treatment-related mortality, high complete remission rate and may prolong long-term survival.