Lei Yangyang, Cai Bo, Liu Zhiqing, Xie Anli, Qiao Jianhui, Wang Yi, Chen Xinrui, Peng Fei, Zhao Yingxin, Chen Jiaxin, Guan Wei, Yu Changlin, Lou Xiao, Hu Kaixun, Zhang Ang, Sun Qiyun, Huang Yajing, Ai Huisheng, Guo Mei
Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing, China.
Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China.
Front Immunol. 2025 Apr 4;16:1509588. doi: 10.3389/fimmu.2025.1509588. eCollection 2025.
Despite advances in the treatment of multiple myeloma, a proportion of patients still hardly achieve desired prognosis. Although microtransplant (MST) has proved promising results in treating several hematological malignancies, it has not been studied in multiple myeloma.
We performed a retrospective analysis of multiple myeloma patients treated with MST at our institution. Their clinical information and outcome measurements were collected. Furthermore, the fluctuation of donor microchimerism after MST, as well as the alteration of immune function before and after MST were analyzed.
Twenty patients receiving MST were enrolled from June 2008, to May 2024, with an overall response rate of 17/20. The 6-year overall survival (OS) and progression-free survival (PFS) rates were 64.7% and 35.3%, respectively, with no graft-versus-host disease or non-relapse mortality. Incidence of controlled fever and Grade I cytokine release syndrome (CRS) was 40.8%. The OS were comparable between groups with age, International Staging System stage, and Mayo Stratification of Myeloma and Risk-Adapted Therapy stage. However, earlier Durie-Salmon stage, disease in VGPR or CR status prior to MST, and an increase in total cycle number of MST were significantly associated with longer OS. Donor microchimerism was detected in all available peripheral blood samples from 14 days to 6 months post-MST. Furthermore, MST resulted in increased proportions of total CD3+ T cells, and CD4+CD8- T cells in peripheral blood, as well as improved CD4:CD8 ratio and increased proportions of Th0 cells.
MST extended PFS and OS, and benefit immune reconstitution in multiple myeloma patients. Therefore, MST is a promising treatment for multiple myeloma, especially those with high-risk cytogenetics.
尽管多发性骨髓瘤的治疗取得了进展，但仍有一部分患者难以达到理想的预后。尽管微移植（MST）已被证明在治疗几种血液系统恶性肿瘤方面取得了有前景的结果，但尚未在多发性骨髓瘤中进行研究。
我们对在本机构接受MST治疗的多发性骨髓瘤患者进行了回顾性分析。收集了他们的临床信息和结局指标。此外，分析了MST后供体微嵌合体的波动情况，以及MST前后免疫功能的变化。
2008年6月至2024年5月共纳入20例接受MST治疗的患者，总缓解率为17/20。6年总生存率（OS）和无进展生存率（PFS）分别为64.7%和35.3%，未发生移植物抗宿主病或非复发死亡率。可控性发热和I级细胞因子释放综合征（CRS）的发生率为40.8%。不同年龄、国际分期系统分期、Mayo骨髓瘤分层及风险适应性治疗分期组之间的OS具有可比性。然而，Durie-Salmon分期较早、MST前处于非常好的部分缓解（VGPR）或完全缓解（CR）状态以及MST总周期数增加与更长的OS显著相关。在MST后14天至6个月的所有可用外周血样本中均检测到供体微嵌合体。此外，MST导致外周血中总CD3+ T细胞、CD4+CD8- T细胞比例增加，CD4:CD8比值改善，Th0细胞比例增加。
MST延长了多发性骨髓瘤患者的PFS和OS，并有利于免疫重建。因此，MST是一种有前景的多发性骨髓瘤治疗方法，尤其是对于具有高危细胞遗传学特征的患者。
