异基因造血干细胞移植治疗多发性骨髓瘤精品.pptVIP

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 linear accelerator or cobalt on day 0 27 patients received additional fludarabine (30 mg/m2) on days 4, 3, and 2 N % Engraftment All 102 allografted patients had sustained engraftment. On day 28, medians of 90%, 95%, and 95% of peripheral blood T cells, granulocytes, and nucleated marrow cells,respectively, were of donor origin. This increased to medians of 96% to 100% on day 84 GVHD 43 patients (42%) developed grades 2 to 4 acute GVHD at a median of 42 (range, 8-107) days 74 patients (74%) developed chronic extensive GVHD at a median of 167 (range, 90-830) days after transplantation. NRM NRM was 1% at day 100 and 11%, 14%, and 18% at 1, 2, and 5 years after allografting, respectively GVHD and infections were responsible for 18 of 19 non relapse related deaths. Overall and progression-free survivals After a median follow-up of 6.3 years after allografting (range 2-9) 60 of 102 (59%)patients survived and 33 of 102 (32%) are in remission Five-year estimated OS and PFS were 64% and 36%,respectively conclusion auto/allo-RIC HCT is a treatment option for patients with advanced stage MM The addition of novel agents (eg,thalido