van Dorp S, Meijer E, van de Donk N W C J, Dekker A W, Nieuwenhuis K, Minnema M C, Petersen E, Schutgens R, Verdonck L F, Lokhorst H M
Department of Haematology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Neth J Med. 2007 May;65(5):178-84.
The role of allogeneic stem cell transplantation in multiple myeloma is not yet established.
We retrospectively evaluated the outcome of nonmyeloablative allogeneic stem cell transplantation (NMA) in patients with multiple myeloma treated at the Department of Haematology of the University Medical Centre Utrecht. Thirty-six patients received NMA as part of the first-line treatment; 23 patients as part of salvage therapy. Conditioning regimen was low-dose total body irradiation (TBI, 2 Grays) only; fludarabine was added in patients without previous autologous stem cell transplantation and patients with matched unrelated donors received antithymocyte globulin in addition to fludarabine and TBI.
Following NMA overall response increased from 84 to 90%, complete remission rate from 15 to 32%. As part of first-line treatment NMA induced complete remission in 50% of patients vs one patient (4%) treated for relapsed multiple myeloma. Median progression-free survival was 26 months (13 months for the salvage group, 38 months for the 'upfront' patients). Median overall survival has not been reached yet. The achievement of complete remission following NMA as part of first-line treatment was associated with prolonged progression-free and overall survival. Major toxicities were acute and chronic graft-vs-host disease occurring in 64% (23% grade 3-4) and in 54% (49% extensive) patients, respectively. Seven patients (12%) died from nonrelapse mortality, five patients (9%) directly related to toxicity of NMA.
NMA in multiple myeloma is feasible, is associated with acceptable nonrelapse mortality and may induce prolonged complete remission. In pretreated patients the result of NMA is disappointing which urges new strategies.
异基因干细胞移植在多发性骨髓瘤中的作用尚未明确。
我们回顾性评估了乌得勒支大学医学中心血液科治疗的多发性骨髓瘤患者接受非清髓性异基因干细胞移植（NMA）的结果。36例患者接受NMA作为一线治疗的一部分；23例患者接受NMA作为挽救治疗的一部分。预处理方案仅为低剂量全身照射（TBI，2格雷）；未接受过自体干细胞移植的患者以及供者为匹配无关供者的患者在接受氟达拉滨和TBI的基础上还加用了抗胸腺细胞球蛋白。
接受NMA后，总体缓解率从84%提高到90%，完全缓解率从15%提高到32%。作为一线治疗的一部分，NMA使50%的患者获得完全缓解，而接受NMA治疗复发多发性骨髓瘤的患者中只有1例（4%）获得完全缓解。无进展生存期的中位数为26个月（挽救治疗组为13个月，“一线”治疗患者为38个月）。总生存期的中位数尚未达到。作为一线治疗的一部分，NMA后获得完全缓解与无进展生存期和总生存期延长相关。主要毒性反应为急性和慢性移植物抗宿主病，分别发生在64%（3 - 4级为23%）和54%（广泛型为49%）的患者中。7例患者（12%）死于非复发死亡率，5例患者（9%）的死亡与NMA的毒性直接相关。
多发性骨髓瘤患者接受NMA是可行的，与可接受的非复发死亡率相关，并且可能诱导长期完全缓解。在经过预处理的患者中，NMA的结果令人失望，这促使人们探索新的策略。
