Cord Blood Transplantation for Multiple Myeloma: A Study from the Multiple Myeloma Working Group of the Japan Society for Hematopoietic Cell Transplantation
Cord Blood Transplantation for Multiple Myeloma: A Study from the Multiple Myeloma Working Group of the Japan Society for Hematopoietic Cell Transplantation
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脐带血移植治疗多发性骨髓瘤：日本造血细胞移植学会多发性骨髓瘤工作组的研究
DOI：
10.1016/j.bbmt.2015.02.015
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Kanda Y
中科院分区：
文献类型：
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作者：
Kawamura K;Takamatsu H;Ikeda T;Komatsu T;Aotsuka N;Amano I;Yamamoto G;Watanabe K;Ohno Y;Matsue K;Kouzai Y;Tsukada N;Ishiyama K;Anzai N;Kato K;Suzuki R;Sunami K;Kanda Y
脐带血已被研究作为造血干细胞移植的替代来源，但有关其用于多发性骨髓瘤的信息有限。本研究的目的是评估脐带血移植（CBT）治疗多发性骨髓瘤患者的可行性。86名多发性骨髓瘤患者在2001年至2011年间接受了第一次CBT治疗，纳入了这项回顾性研究。其中62人在CBT前接受过其他类型的干细胞移植。第50天中性粒细胞植入、II至IV级急性移植物抗宿主病（GVHD）和慢性GVHD的累积发生率分别为81.4%、39.0%和19.5%。2年非复发死亡率的发生率为39.0%，但在接受计划的串联自体/降低强度调节CBT （auto/RIC-CBT）的患者中仅为6.2%。6年无进展生存期（PFS）和总生存期（OS）分别为13.0%和15.2%。CBT前未达到部分缓解和未进行移植是PFS的独立显著不良因素，而既往移植和计划的串联移植与更好的OS相关。接受auto/RIC-CBT的患者6年生存率为45.9%。此外，慢性GVHD的发展与较好的PFS相关。总之，我们证明脐带血作为骨髓瘤患者的替代移植物来源是可行的。虽然CBT为一小部分患者提供了长期生存，但这种移植物的最佳使用需要进一步的临床研究。
Cord blood has been investigated as an alternative source for hematopoietic stem cell transplantation, but information about its use for multiple myeloma is limited. The purpose of this study was to evaluate the feasibility of cord blood transplantation (CBT) for patients with multiple myeloma. Eighty-six patients with multiple myeloma who underwent a first CBT between 2001 and 2011 were included in this retrospective study. Sixty-two of them had received other types of stem cell transplantation before CBT. The cumulative incidences of neutrophil engraftment at day 50, grade II to IV acute graft-versus-host disease (GVHD), and chronic GVHD were 81.4%, 39.0%, and 19.5%, respectively. The incidence of nonrelapse mortality at 2 years was 39.0%, but it was only 6.2% in patients who underwent planned tandem autologous/reduced-intensity conditioning CBT (auto/RIC-CBT). Progression-free survival (PFS) and overall survival (OS) at 6 years were 13.0% and 15.2%, respectively. Less than a partial response before CBT and lack of prior transplantation were independent significant adverse factors for PFS, whereas the presence of prior transplantation and planned tandem transplantation were associated with better OS. OS at 6 years in patients who underwent auto/RIC-CBT was 45.9%. In addition, the development of chronic GVHD was associated with superior PFS. In conclusion, we demonstrated that cord blood is feasible as an alternative graft source for myeloma patients. Although CBT provided long-term survival for a fraction of patients, optimal use of this graft requires further clinical studies.