Ma S Y, Lie A K W, Au W Y, Chim C S, Kwong Y L, Liang R
Division of Haematology and Oncology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Hong Kong Med J. 2004 Apr;10(2):77-83.
To present an institution's 2-year experience of non-myeloablative allogeneic stem cell transplantation among Chinese patients.
Retrospective study.
Bone marrow transplantation unit at a university hospital, Hong Kong.
Ten patients with multiple myeloma who received non-myeloablative allogeneic stem cell transplantation between March 2000 and October 2002.
Fludarabine (90 mg/m(2)) and total body irradiation (300 cGy) were given as conditioning regimens, followed by non-myeloablative allogeneic stem cell transplantation.
Engraftment, regimen-related toxicity, treatment-related mortality (in the first 100 days), incidence of graft-versus-host disease, chimerism, disease response, and survival rate.
All 10 patients had active disease before transplantation. The donors were eight human leukocyte antigen-matched siblings, a mismatched sibling, and a matched daughter. Satisfactory engraftment before day 21 was achieved without early treatment-related mortality. Five patients developed full donor chimerism by day 28 and three other patients had 100% donor chimerism by day 100. Acute graft-versus-host disease developed in six patients (five with grade III and one with grade IV disease), and chronic graft-versus-host disease developed in eight patients (four with extensive disease). Complete remission and partial response were achieved in three and four patients, respectively. Three patients did not respond to treatment, and one case of relapse was observed. Only one patient, who had shown a partial response, received donor lymphocyte infusion; seven patients received thalidomide for graft-versus-host disease with or without graft-versus-myeloma effect. All patients were alive after a median follow-up of 1 year.
Non-myeloablative allogeneic stem cell transplantation for multiple myeloma is effective, has low toxicity, and results in low treatment-related mortality. Studies of more cases with longer follow-up durations are required.
介绍一所机构在中国患者中进行非清髓性异基因干细胞移植的2年经验。
回顾性研究。
香港一所大学医院的骨髓移植科。
2000年3月至2002年10月期间接受非清髓性异基因干细胞移植的10例多发性骨髓瘤患者。
采用氟达拉滨（90mg/m²）和全身照射（300cGy）作为预处理方案，随后进行非清髓性异基因干细胞移植。
植入情况、方案相关毒性、治疗相关死亡率（移植后100天内）、移植物抗宿主病发生率、嵌合状态、疾病反应及生存率。
所有10例患者移植前均患有活动性疾病。供者包括8例人类白细胞抗原匹配的同胞、1例不匹配的同胞及1例匹配的女儿。21天前均实现了满意的植入，且无早期治疗相关死亡。5例患者在第28天出现完全供者嵌合，另外3例患者在第100天出现100%供者嵌合。6例患者发生急性移植物抗宿主病（5例为Ⅲ级，1例为Ⅳ级），8例患者发生慢性移植物抗宿主病（4例为广泛性疾病）。分别有3例和4例患者达到完全缓解和部分缓解。3例患者对治疗无反应，观察到1例复发。仅1例出现部分缓解的患者接受了供者淋巴细胞输注；7例患者接受沙利度胺治疗移植物抗宿主病，部分患者有移植物抗骨髓瘤效应。中位随访1年后所有患者均存活。
非清髓性异基因干细胞移植治疗多发性骨髓瘤有效、毒性低且治疗相关死亡率低。需要开展更多病例、更长随访时间的研究。
