Lenalidomide plus donor-lymphocytes infusion after allogeneic stem-cell transplantation with reduced-intensity conditioning in patients with high-risk multiple myeloma
Lenalidomide plus donor-lymphocytes infusion after allogeneic stem-cell transplantation with reduced-intensity conditioning in patients with high-risk multiple myeloma
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DOI：
10.1016/j.exphem.2012.02.009
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发表时间：
2012-07-01
影响因子：
2.6
通讯作者：
Blaise, Didier
中科院分区：
文献类型：
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作者：
El-Cheikh, Jean;Crocchiolo, Roberto;Blaise, Didier
骨髓瘤复发是异基因造血干细胞移植后死亡的主要原因。我们的观察性研究的目的是评价来那度胺联合供者淋巴细胞输注（DLI）作为移植后过继免疫治疗的抗骨髓瘤作用。分析了12例难治性骨髓瘤患者。移植时的中位年龄为56岁（范围：46-64岁）。所有患者均接受低强度条件反射。如果在第+100天观察到疾病进展或残留，并且没有明显的移植物抗宿主病体征，则纳入患者。来那度胺治疗两个周期后给予DLI。来那度胺的中位剂量为15 mg（范围：10-25 mg）。患者接受中位6个周期（范围，1-10个周期）。9例患者（60%）接受了递增剂量的DLI。1年和2年无进展生存率分别为75%和50%，总生存率分别为83%和69%。未达到中位总生存期，中位无进展生存期为23个月。来那度胺在同种异体干细胞移植后耐受性良好;与DLI联合使用不会导致移植物抗宿主病风险升高;该策略可能存在免疫协同效应。这种组合应在更大的患者队列中进一步评估。(C)2012 ISEH -血液学和干细胞学会。爱思唯尔公司出版
Myeloma relapse is the main cause of death after allogeneic stem cell transplantation. The aim of our observational study was to evaluate the anti-myeloma effect of lenalidomide followed by donor-lymphocyte infusion (DLI) as post-transplantation adoptive immunotherapy. Twelve patients with refractory myeloma were analyzed. The median age at transplantation was 56 years (range, 46-64 years). All patients received reduced-intensity conditioning. Patients were included if progressive or residual disease was observed at day +100 and if no signs of graft-vs-host disease were evident. DLIs were administered after two cycles of lenalidomide. Median dose of lenalidomide was 15 mg (range, 10-25 mg). Patients received a median of six cycles (range, 1-10 cycles). Nine patients (60%) received an escalating dose of DLI. The 1 and 2-year probability of progression-free survival was 75% and 50%, and overall survival was 83% and 69%, respectively. Median overall survival was not reached and median progression-free survival was 23 months. Lenalidomide is well tolerated after allogeneic stem cell transplantation; the combination with DLI did not cause a higher risk of graft-vs-host disease; an immunological synergistic effect was probably present with this strategy. This combination should be evaluated further in a larger cohort of patients. (C) 2012 ISEH - Society for Hematology and Stem Cells. Published by Elsevier Inc.