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Non-myeloablative allogeneic peripheral stem cell
transplantation for multiple myeloma
SY Ma, AKW Lie, WY Au, CS
Chim, YL Kwong, R Liang
Division of Haematology and Oncology, Department of Medicine, The
University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong
Kong
OBJECTIVE. To present an institution's 2-year experience
of non-myeloablative allogeneic stem cell transplantation among
Chinese patients.
DESIGN. Retrospective study.
SETTING. Bone marrow transplantation unit at a university
hospital, Hong Kong.
PATIENTS. Ten patients with multiple myeloma who
received non-myeloablative allogeneic stem cell transplantation
between March 2000 and October 2002.
INTERVENTION. Fludarabine (90 mg/m2 )
and total body irradiation (300 cGy) were given as conditioning
regimens, followed by non-myeloablative allogeneic stem cell transplantation.
MAIN OUTCOME MEASURES. Engraftment, regimen-related
toxicity, treatment-related mortality (in the first 100 days), incidence
of graft-versus-host disease, chimerism, disease response, and survival
rate.
RESULTS. All 10 patients had active disease before
transplantation. The donors were eight human leukocyte antigen-matched
siblings, a mismatched sibling, and a matched daughter. Satisfactory
engraftment before day 21 was achieved without early treatment-related
mortality. Five patients developed full donor chimerism by day 28
and three other patients had 100% donor chimerism by day 100. Acute
graft-versus-host disease developed in six patients (five with grade
III and one with grade IV disease), and chronic graft-versus-host
disease developed in eight patients (four with extensive disease).
Complete remission and partial response were achieved in three and
four patients, respectively. Three patients did not respond to treatment,
and one case of relapse was observed. Only one patient, who had
shown a partial response, received donor lymphocyte infusion; seven
patients received thalidomide for graft-versus-host disease with
or without graft-versus-myeloma effect. All patients were alive
after a median follow-up of 1 year.
CONCLUSION. Non-myeloablative allogeneic stem cell
transplantation for multiple myeloma is effective, has low toxicity,
and results in low treatment-related mortality. Studies of more
cases with longer follow-up durations are required.
Hong Kong Med J 2004;10:77-83
Key words: Multiple myeloma; Myeloablative agents;
Transplantation
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