[临床医学]异基因造血干细胞移植治疗多发性骨髓瘤.ppt

The allogeneic transplant has the advantage over the autologous transplant The graft does not contain tumor cells and the potential for a graft versus myeloma (GvM) effect Bone marrow transplantation in three patients with multiple myeloma Gahrton G, Ringdén O, L?nnqvist B, Lindquist R, Ljungman P. Three patients with multiple myeloma received bone marrow grafts from HLA-identical sibling donors One of the patients, with IgA kappa myeloma, refractory to alkeran-prednisone therapy, is well and still without sign of disease 26 months post transplantation A second patient with Bence-Jones kappa myeloma is well, and skeletal pain and Bence-Jones proteinuria has disappeared 2 months after transplantation. A third patient with IgG-lambda myeloma died of effusive pericarditis shortly after transplantation. Conclusion Bone marrow transplantation may be indicated in a selective group of patients with multiple myeloma Conditiong regime Engraftment GVHD Treatment –related mortality Treatment –related mortality Relapse rate Relapse rate Survival Survival Progression –free survival Cause of death Cause of death Conditioning regime conclusion Autologous HCT. (G-CSF) mobilized peripheral blood mononuclear cells (G-PBMC) were harvested by leukapheresis after treatment with cyclophosphamide 3 to 4 g/m2 (day 1) and G-CSF 10 g/kg subcutaneously (from day 3 through collection) Autologous HCT 38 patients received additional paclitaxel (250 mg/m2 per day, day 2), and 25 received additional etoposide (200 mg/m2 per day; days 1, 2, 3) and dexamethasone (10 mg/day orally; days 1, 2,3, 4) Two patients received G-CSF alone. Autologous HCT No treatment for MM was given between autologous and allogeneic HCT Allogeneic HCT After recovery from autologous HCT 102 patientsproceeded to allotransplantation. Donors were HLA-identical siblings Nonmyeloablative conditioning consisted in all patients of 2 Gy total body irradiation (TBI) at 7 cGy/min by linea