Smith Eric, Devlin Sean M, Kosuri Satyajit, Orlando Evelyn, Landau Heather, Lesokhin Alex M, Chung David J, Hassoun Hani, Lendvai Nikoletta, Landgren Ola, Giralt Sergio, Chari Ajai, Jagannath Sundar, Koehne Guenther
Hematology/Oncology/BMT Fellowship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York.
Biol Blood Marrow Transplant. 2016 Feb;22(2):258-267. doi: 10.1016/j.bbmt.2015.08.025. Epub 2015 Aug 30.
We report results of a retrospective analysis of 44 patients with relapsed and high-risk multiple myeloma (MM) undergoing allogeneic CD34-selected hematopoietic stem cell transplantation (HSCT) from HLA-compatible donors. Patients had multiply relapsed disease including relapse at <15 months after autologous transplantation and most patients (28 of 44; 65%) also had high-risk cytogenetics. Before transplantation, patients received busulfan (.8 mg/kg × 10 doses), melphalan (70 mg/m(2) × 2 days), fludarabine (25 mg/m(2) × 5 days), and rabbit antithymocyte globulin (2.5 mg/kg × 2 days). Patients with 10/10 HLA- matched donors were treated prophylactically with low doses of donor lymphocyte infusions (.5 to 1 × 10(6) CD3(+)/kg) starting 4 to 6 months after CD34-selected HSCT. Acute (grade II to IV) graft-versus-host disease (GVHD) and transplantation-related mortality at 12 months were 2% and 18%, respectively. Chronic GVHD was not observed in any patient. Overall and progression-free survival at 2 years were 54% and 31%, respectively. By multivariate analyses, the outcomes of CD34-selected HSCT were influenced by presence of extramedullary disease, disease status before CD34-selected HSCT, and age. This study demonstrates notable safety and efficacy of CD34-selected HSCT in patients with multiply relapsed MM, including those with high-risk cytogenetics.
我们报告了对44例复发及高危多发性骨髓瘤（MM）患者进行回顾性分析的结果，这些患者接受了来自HLA匹配供者的经CD34选择的异基因造血干细胞移植（HSCT）。患者患有多次复发性疾病，包括自体移植后<15个月复发，且大多数患者（44例中的28例；65%）还具有高危细胞遗传学特征。移植前，患者接受白消安（0.8 mg/kg×10剂）、美法仑（70 mg/m²×2天）、氟达拉滨（25 mg/m²×5天）和兔抗胸腺细胞球蛋白（2.5 mg/kg×2天）治疗。对于10/10 HLA匹配供者的患者，在经CD34选择的HSCT后4至6个月开始预防性给予低剂量供者淋巴细胞输注（0.5至1×10⁶ CD3⁺/kg）。急性（II至IV级）移植物抗宿主病（GVHD）和12个月时的移植相关死亡率分别为2%和18%。未在任何患者中观察到慢性GVHD。2年时的总生存率和无进展生存率分别为54%和31%。通过多变量分析，经CD34选择的HSCT的结果受髓外疾病的存在、经CD34选择的HSCT前的疾病状态和年龄影响。本研究证明了经CD34选择的HSCT在多次复发的MM患者（包括具有高危细胞遗传学特征的患者）中具有显著的安全性和有效性。
