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1、Allogeneic haematopoietic cell transplantation for multiple myelomanThe allogeneic transplant has the advantage over the autologous transplantnThe graft does not contain tumor cells and the potential for a graft versus myeloma (GvM) effectBone marrow transplantation in three patients with multiple m
2、yelomaGahrton G, Ringdn O, Lnnqvist B, Lindquist R, Ljungman P.Acta Med Scand 1986;219(5):523-7.瑞典卡罗林斯卡医学院 1983Myeloablative conditioning n Three patients with multiple myeloma received bone marrow grafts from HLA-identical sibling donorsn One of the patients, with IgA kappa myeloma, refractory to a
3、lkeran-prednisone therapy, is well and still without sign of disease 26 months post transplantationn A second patient with Bence-Jones kappa myeloma is well, and skeletal pain and Bence- Jones proteinuria has disappeared 2 months after transplantation.n A third patient with IgG-lambda myeloma died o
4、f effusive pericarditis shortly after transplantation. Acta Med Scand 1986;219(5):523-7Conclusion n Bone marrow transplantation may be indicated in a selective group of patients with multiple myelomaActa Med Scand 1986;219(5):523-7n Out of 690 allogenetic matched sibling donor transplants for MM n 3
5、44 were performed during the period 1983- 93(all with BM ) group 1n 356 during 1994-98 (223 with BM group 2 and 133 with PB group 3)u the median age at transplantation of patients in group 1 was 43 years (range 21-62)uIn group 2 ,44 years (range 18_57) and in group 3, 46 years (range 25_60)u TBI+CY
6、tended to be more commonly used in group 1(37%) and 2 (39%) than in group 3 (27%)uMelphalan containing regimes tended to be morely used in group 3 uMelphalan or Busulphan + CY rarely nConditiong regimeEngraftmentGVHD Treatment related mortalityTreatment related mortalityRelapse rate Relapse rate Sur
7、vivalSurvivalnProgression free survivalu PFS was significantly better for group 2than for group 1(P0.0001)uWith no significantly difference between group 2 and 3nCause of death u 75% in group 1,36% in group 2 ,33 % in group 3 uGVHD uFungal uARDS uOrgan failurenCause of death u the study shows that t
8、he improvement is entirely a result of a lower TRM during the latest 5-years periodu aGVHD has no changed during this peroid uThere was significant difference in deaths caused by IP and bacterial and fungalinfectionConditioning regime u TBI+Melphalan has not previrous been Shown to be superior to TB
9、I+CY in this studynconclusion n Survival u 3060% nTreatment related mortality u30%Myeloablative allogeneic versus autologous transplantationnduring the years 1983 to 1994n189 myeloma patients who underwent allo- BMT with an HLA-identical sibling donor were compared retrospectively with an equal numb
10、er of patients who receiveda single autologous bone marrow or blood stem cell graftnAnd the ASCT patients were transplanted from 1986 to 1994nconclusion n The overall survival was significantly better for ASCT than for allo-BMT, with a median survival of 34 months and 18 months, respectively (P = .0
11、01), uThe main reason for the poorer survival in allo- BMT patients was higher TRM (41% v 13% for ASCT, P = .0001), which was not compensated for by a lower rate of relapse and progressionn conclusionn However, in patients alive at 1 year posttransplant, there was a trend for better long-term surviv
12、al (P = .O9) and significantly better progression-free survival (P = .02) for allo-BMT as compared with ASCTn We conclude that the median survival is superior for ASCTn However, allo-BMT has a lower relapse rate, which results in a similar long-term outcome for both approaches, but a longer follow-u
13、p is needed to assess the final outcomeReduced-intensity conditioning allogeneic transplantationnThe Allo-RIC was introduced in an attempt to decrease the transplant- related toxicity while retaining the beneficial GvM effectn1998 begin clinical studyn 19982003nWe report the outcome of 229 patients
14、who received an allograft for myeloma with reduced-intensity conditioning (RIC) regimens from 33 centers within the EBMT.n With a median follow-up of 28 months, 115 patients are alive(range, 1-53 months)n The estimated overall survival at 3 yearsis 40.6% (CI, 33%-49%) n The treatment-related mortali
15、ties at day 100, 1 year,and 2 years were 10%, 22%, and 26%, respectively.n The cumulative probability of the progression- free survival was 21.3% (CI, 15%-29%) at 3yearsnConclusionnWhile RIC is feasible, heavily pretreated patients and patients with progressive disease do not benefitRIC vs MACnData
16、were available on a total of 516 patients from 103 centers: 320 patients with RIC and 196 with MAC.nbetween January 1, 1998, to December 31, 2002nThe median follow-up was 28 monthsnconclusion n RIC was associated with a reduction in TRM but this was offset by an increase in relapse risk nthe conditioning intensity did not impact on
