van der Griend R, Verdonck L F, Petersen E J, Veenhuizen P, Bloem A C, Lokhorst H M
Department of Hematology, University Hospital Utrecht, The Netherlands.
Bone Marrow Transplant. 1999 Jan;23(2):195-7. doi: 10.1038/sj.bmt.1701546.
We describe a patient with recurrent relapses after allogeneic BMT for multiple myeloma who repeatedly went into CR after donor leukocyte infusions (DLI). The first bone marrow relapse, 24 months after allogeneic BMT, was treated successfully with the infusion of 1.2 x 10(8) donor T cells. The second extramedullary relapse, 18 months later with a pleural mass and midthoracic spine process, responded again to DLI, however, only after three courses were given, each with escalating doses of T cells. The pleural mass was treated successfully with radiation therapy after the second DLI but reappeared 3 months later and responded again to the final DLI course with 5 x 10(8) T cells/kg. Nevertheless, graft-versus-host disease (GVHD) did not occur. Retrospective analysis of minimal residual disease in bone marrow aspirates during CR periods using a sensitive quantitative tumor-specific PCR showed that BM tumor cell infiltration persisted. The possible clinical implications of this case report, like maintenance DLI and the aim for molecular remissions, are discussed.
我们描述了一名多发性骨髓瘤患者，在接受异基因骨髓移植后复发，经供体白细胞输注（DLI）后多次进入完全缓解（CR）状态。异基因骨髓移植后24个月出现首次骨髓复发，输注1.2×10⁸个供体T细胞成功治疗。18个月后出现第二次髓外复发，伴有胸腔肿块和胸中段脊柱病变，再次对DLI有反应，但仅在给予三个疗程、每个疗程T细胞剂量递增后出现反应。第二次DLI后，胸腔肿块经放射治疗成功，但3个月后再次出现，对最后一个5×10⁸个T细胞/kg的DLI疗程再次有反应。然而，未发生移植物抗宿主病（GVHD）。使用敏感的定量肿瘤特异性聚合酶链反应（PCR）对CR期骨髓穿刺物中的微小残留病进行回顾性分析表明，骨髓肿瘤细胞浸润持续存在。本文讨论了该病例报告可能的临床意义，如维持性DLI以及实现分子缓解的目标。
