早期进行同胞及非亲缘异基因造血干细胞移植治疗45岁以下多发性骨髓瘤

 目的　了解早期进行同胞及非亲缘异基因造血干细胞移植治疗45岁以下多发性骨髓（MM）的疗效及不良反应。方法　3例38～44岁的MM患者，在两疗程化疗达到缓解后，早期进行HLA相合异基因造血干细胞移植，其中例1、2为同胞供者，例3为非亲缘供者。例1、2预处理方案采用氟达拉滨、白消安联合环磷酰胺，预防移植物抗宿主病（GVHD）采用甲氨蝶呤联合环孢素A。例3预处理方案采用改良白消安、环磷酰胺联合抗胸腺细胞免疫球蛋白，预防GVHD采用吗替麦考酚酯、甲氨蝶呤联合环孢素A。结果　3例患者均移植成功，例1出现Ⅱ度急性GVHD及广泛型慢性GVHD，例2、3均未出现GVHD，至今随诊时间为48、27、6个月，3例均至今均生存，无疾病复发迹象。结论　对45岁以下的MM患者，化疗缓解后，早期进行HLA相合的同胞及非亲缘异基因造血干细胞移植治疗，移植相关死亡率较低，完全缓解率高，有可能长期生存。

Sibling and unrelated allogeneic hematopoietic stem cell transplantation for multiple myeloma patients under 45-year-old at early stage

Objective To evaluate the effectiveness and side effects in sibling and unrelated HLA identical allogeneic hematopoietic stem cell transplantation for multiple myeloma patients under 45-year-old at early stage. Methods Three patients with multiple myeloma ranged from 38 to 44-year-old received two courses of chemotherapies and achieved partial remission. Sibling HLA identical allogeneic hematopoietic stem cell transplantations were underwent in case 1 and 2, and unrelated were in case 3. The conditioning regimens for case 1 and 2 included fludarabine, busulfan plus cyclophosphamide, and of case 3 included modified busulfan, cyclophosphamide plus antithymocyte globulin. Cycloporine A combined with methotrexate were used to prevent GVHD in the case 1 and 2, and methotrexate, mycophenolate and cycloporine A were used in case 3. Results All patients achieved full donor chimerism without graft failure. Grade Ⅱ acute GVHD and extensive chronic GVHD were found in case 1, but not in case 2 and 3. The period of follow-up of case 1, 2 and 3 were 48, 27 and 6 months, respectively, and all of them were alive with no signs of relapse. Conclusion The multiple myeloma patients under 45-year-old underwent sibling and unrelated HLA identical allogeneic hematopoietic stem cell transplantation at early stage after chemotherapy remission have the low treatment-related mortality, high complete remission rate and may prolong long-term survival.