Anderson K C, Andersen J, Soiffer R, Freedman A S, Rabinowe S N, Robertson M J, Spector N, Blake K, Murray C, Freeman A
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA 02115.
Blood. 1993 Oct 15;82(8):2568-76.
Forty patients with plasma cell dyscrasias underwent high-dose chemoradiotherapy and either anti-B-cell monoclonal antibody (MoAb)-treated autologous, anti-T-cell MoAb-treated HLA-matched sibling allogeneic or syngeneic bone marrow transplantation (BMT). The majority of patients had advanced Durie-Salmon stage myeloma at diagnosis, all were pretreated with chemotherapy, and 17 had received prior radiotherapy. At the time of BMT, all patients demonstrated good performance status with Karnofsky score of 80% or greater and had less than 10% marrow tumor cells; 34 patients had residual monoclonal marrow plasma cells and 38 patients had paraprotein. Following high-dose chemoradiotherapy, there were 18 complete responses (CR), 18 partial responses, one non-responder, and three toxic deaths. Granulocytes greater than 500/microL and untransfused platelets greater than 20,000/microL were noted at a median of 23 (range, 12 to 46) and 25 (range, 10 to 175) days posttransplant (PT), respectively, in 24 of the 26 patients who underwent autografting. In the 14 patients who received allogeneic or syngeneic grafts, granulocytes greater than 500/microL and untransfused platelets greater than 20,000/microL were noted at a median of 19 (range, 12 to 24) and 16 (range, 5 to 32) days PT, respectively. With 24 months median follow-up for survival after autologous BMT, 16 of 26 patients are alive free from progression at 2+ to 55+ months PT; of these, 5 patients remain in CR at 6+ to 55+ months PT. With 24 months median follow-up for survival after allogeneic and syngeneic BMT, 8 of 14 patients are alive free from progression at 8+ to 34+ months PT; of these, 5 patients remain in CR at 8+ to 34+ months PT. This therapy has achieved high response rates and prolonged progression-free survival in some patients and proven to have acceptable toxicity. However, relapses post-BMT, coupled with slow engraftment post-BMT in heavily pretreated patients, suggest that such treatment strategies should be used earlier in the disease course. To define the role of BMT in the treatment of myeloma, its efficacy should be compared with that of conventional chemotherapy in a randomized trial.
40例浆细胞异常增生患者接受了大剂量放化疗，并接受了抗B细胞单克隆抗体（MoAb）治疗的自体、抗T细胞MoAb治疗的HLA匹配同胞异基因或同基因骨髓移植（BMT）。大多数患者在诊断时处于Durie-Salmon晚期骨髓瘤，均接受过化疗预处理，17例曾接受过放疗。在进行BMT时，所有患者的身体状况良好，卡诺夫斯基评分达80%或更高，骨髓肿瘤细胞少于10%；34例患者有残留的单克隆骨髓浆细胞，38例患者有副蛋白。大剂量放化疗后，有18例完全缓解（CR），18例部分缓解，1例无反应，3例因毒性死亡。26例接受自体移植的患者中，分别在移植后（PT）中位数为23天（范围12至46天）和25天（范围10至175天）时，观察到粒细胞大于500/μL且未输注血小板大于20,000/μL。在14例接受异基因或同基因移植的患者中，分别在PT中位数为19天（范围12至24天）和16天（范围5至32天）时，观察到粒细胞大于500/μL且未输注血小板大于20,000/μL。自体BMT后生存的中位数随访24个月，26例患者中有16例在PT 2+至55+个月时存活且无疾病进展；其中，5例患者在PT 6+至55+个月时仍处于CR状态。异基因和同基因BMT后生存的中位数随访24个月，14例患者中有8例在PT 8+至34+个月时存活且无疾病进展；其中，5例患者在PT 8+至34+个月时仍处于CR状态。这种治疗方法在一些患者中取得了高缓解率并延长了无进展生存期，且毒性可接受。然而，BMT后的复发，加上经过大量预处理的患者BMT后植入缓慢，提示这种治疗策略应在疾病病程中更早使用。为了确定BMT在骨髓瘤治疗中的作用，应在一项随机试验中将其疗效与传统化疗的疗效进行比较。
