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目的:研究非清髓性造血干细胞移植(NST)治疗多发性骨髓瘤(MM)的疗效,观察移植相关并发症的发生。方法:1例42岁MM患者,供者为其胞姐,HLA配型完全相合。动员方案:粒细胞集落刺激因子(G CSF)10μg·kg-1·d-1×5 d。预处理方案:抗胸腺细胞球蛋白(ATG)8 mg·kg-1 ·d-1 ×3 d,马法兰(MEL)120 mg/m2×1 d。移植单个核细胞数(MNC)6.5×108/kg;CD34+ 细胞4.4×106/kg。环胞菌素A(CsA)和短程甲氨蝶呤(MTX)预防移植物抗宿主病(GVHD)。移植后分别于+41 d、+76 d和+112 d进行3次供者淋巴细胞输注(DLI)。结果:移植后15 d中性粒细胞计数>0.5×109/L,21 d血小板计数>50×109/L,24 d性染色体和微卫星法DNA指纹图监测显示为混合嵌合体,随着DLI的进行,逐渐转为供者型完全嵌合体,骨髓瘤细胞和血清M蛋白均逐渐消失,移植后8个月达完全缓解。在+180 d(第三次DLI后68 d)发生II度急性GVHD,经甲泼尼龙和CsA治疗得以控制。现随访36个月,患者情况良好,仍处于完全缓解状态。结论:非清髓性造血干细胞移植加供者淋巴细胞输注治疗MM是可行和有效的。
Objective: To investigate the efficacy of non-myeloablative hematopoietic stem cell transplantation (NST) in the treatment of multiple myeloma (MM) and to observe the incidence of transplant-related complications. Methods: A 42-year-old MM patient whose donor was his sister sister was completely matched with HLA matching. Mobilization program: Granulocyte colony stimulating factor (G CSF) 10μg · kg-1 · d-1 × 5d. Pretreatment protocol: anti-thymocyte globulin (ATG) 8 mg · kg-1 · d-1 × 3 d, melphalan (MEL) 120 mg / m2 × 1 d. Transplantation of mononuclear cells (MNC) 6.5 × 108 / kg; CD34 + cells 4.4 × 106 / kg. Cyclosporin A (CsA) and short-range methotrexate (MTX) prevent graft versus host disease (GVHD). Three donor lymphocyte infusions (DLI) were performed at +41 d, +76 d, and +112 d after transplantation. Results: On the 15th day after transplantation, the neutrophil count> 0.5 × 109 / L, the platelet count at 21 d> 50 × 109 / L, the 24 d sex chromosome and microsatellite DNA fingerprinting showed mixed chimerism. , And gradually turned into donor-type complete chimerism. The myeloma cells and serum M protein gradually disappeared and reached complete remission at 8 months after transplantation. Grade II Acute GVHD occurred at 180 days (68 days after the third DLI) and was controlled by methylprednisolone and CsA. Now follow-up of 36 months, patients in good condition, is still in complete remission. Conclusion: Non-myeloablative hematopoietic stem cell transplantation plus donor lymphocyte infusion in the treatment of MM is feasible and effective.