Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality
Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality
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DOI：
10.1182/blood-2002-04-1150
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发表时间：
2002-12-01
期刊：
影响因子：
20.3
通讯作者：
Zander, AR
中科院分区：
文献类型：
--
作者：
Kröger, N;Sayer, HG;Zander, AR
我们研究了21例晚期II/III期多发性骨髓瘤患者在接受低强度预处理方案（包括氟达拉滨（150 mg/m2）、美法仑（100-140 mg/m2）和抗胸腺细胞球蛋白（ATG; 10 mg/kg，3天））后进行无关干细胞移植的可行性。患者年龄中位数为50岁（范围：32-61岁）。年）。所有患者既往均接受过至少一次自体移植，其中9例为自体-同种异体串联方案的一部分。未观察到移植物失效。在第40天，在所有患者中检测到完全供体嵌合体。8例患者（38%）发生II至IV级急性移植物抗宿主病（GVHD），4例患者（19%）发生重度III/IV级GVHD。6例患者（37%）发生慢性GVHD，但仅2例患者（12%）发生广泛慢性GVHD。在第100天，估计的非复发死亡概率为10%，在1年为26%。同种异体移植后，40%的患者达到完全缓解，50%达到部分缓解，总有效率为90%。中位随访13个月后，2年估计总体生存率和无进展生存率分别为74%（95% CI，54%-94%）和53%（95% CI，29%-87%）。在既往自体移植复发的患者中观察到较短的无进展生存期（26% vs 86%，P = 0.04）。在非亲缘干细胞移植后采用移植前ATG进行剂量降低预处理，可提供持久的植入和供体嵌合体，显著降低移植相关器官毒性的风险，并诱导高缓解率。(C)2002年，美国血液学会。
We investigated the feasibility of unrelated stem cell transplantation in 21 patients with advanced stage II/III multiple myeloma after a reduced-intensity conditioning regimen, consisting of fludarabine (150 mg/m(2)), melphalan (100-140 mg/m(2)), and antithymocyte globulin (ATG; 10 mg/kg on 3 days). The median patient age was 50 years (range, 32-61. years). All patients had received at least one prior autologous transplantation, in 9 cases as part of an autologous-allogeneic tandem protocol. No graft failure was observed. At day 40 complete donor chimerism was detected in all patients. Grade II to IV acute graft-versus-host disease (GVHD) was seen in 8 patients (38%), and severe grade III/IV GVHD was observed in 4 patients (19%). Six patients (37%) developed chronic GVHD, but only 2 patients (12%) experienced extensive chronic GVHD. The estimated probability of nonrelapse mortality at day 100 was 10% and at 1 year was 26%. After allografting, 40% of the: patients achieved a complete remission; and 50% achieved a partial remission, resulting in an overall response rate of 90%. After a median follow-up of 13 months, the 2-year estimated overall and progression-free survival rates are 74% (95% CI, 54%-94%) and 53% (95% CI, 29%-87%), respectively. A shorter progression-free survival was seen in patients who already experienced relapse to prior autograft (26% versus 86%, P =.04). Dose-reduced conditioning with pretransplantation ATG followed by unrelated stem cell transplantation provides durable engraftment and donor chimerism, reduces substantially the risk of transplant-related organ toxicity, and induces high remission rates. (C) 2002 by The American Society of Hematology.