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目的:探讨异基因造血干细胞移植（allo-HSCT）治疗高危多发性骨髓瘤（MM）的效果和预后影响因素。方法:回顾性分析2003年4月至2017年3月海军军医大学附属长征医院44例确诊并行allo-HSCT的高危MM患者临床资料。分析患者总有效率、复发率、非复发相关死亡（NRM）率、移植物抗宿主病（GVHD）发生率等；采用Kaplan-Meier法分析患者移植后总生存（OS）、无进展生存（PFS）；采用Cox比例风险模型对预后影响因素进行回归分析。结果:44例患者移植后有38例可评估疗效。中位随访时间111个月（0~216个月），其中22例生存，22例死亡，21例复发。移植前完全缓解（CR）率29.5%（13/44），非常好的部分缓解（VGPR）率45.5%（20/44），部分缓解（PR）率22.7%（10/44），疾病稳定（SD）率2.3%（1/44）；移植后CR率71.1%（27/38），VGPR率13.2%（5/38），PR率13.2%（5/38），疾病进展（PD）率2.6%（1/38）。5年OS率、PFS率分别为51.8%、47.8%，10年OS率、PFS率分别为51.3%、43.1%。5、10年累积疾病复发率分别为38.6%、45.4%，5年累积NRM率为25.0%。急性GVHD发生率为38.6%（17/44），其中3~4级急性GVHD发生率为6.8%（3/44）；慢性GVHD发生率为27.3%（12/44）。移植前使用硼替佐米（n HR=3.461，95% n CI 1.211~9.880，n P=0.020）和移植后感染（n HR=0.283，95% n CI 0.098~0.819，n P=0.020）是移植后OS的独立影响因素。n 结论:allo-HSCT能够克服MM高危因素，是高危MM患者值得尝试的治疗手段。移植前使用硼替佐米和移植后感染可能是高危MM患者移植后OS的重要影响因素。“,”Objective:To investigate the effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of high-risk multiple myeloma (MM) patients and its influencing factors of the prognosis.Methods:The clinical data of 44 high-risk MM patients treated with allo-HSCT in Changzheng Hospital Affiliated of Naval Military Medical University from April 2003 to March 2017 were retrospectively analyzed. The overall response rate (ORR), relapse rate, non-relapse-related death (NRM) rate, graft-versus-host disease (GVHD) incidence of patients were also analyzed. Kaplan-Meier was used to analyze the overall survival (OS) rate and progression-free survival (PFS) rate after transplantation. Cox proportional hazard model was used to make regression analysis of the factors affecting the prognosis.Results:Among 44 patients, 38 cases could be evaluated for efficacy after transplantation. The median follow-up time was 111 months (0-216) months, 22 cases survived, 22 cases died, 21 cases relapsed. Before transplantation, complete remission (CR) rate was 29.5%(13/44), very good partial remission(VGPR) rate was 45.5%(20/44), partial remission (PR) rate was 22.7% (10/44), stable disease (SD) rate was 2.3% (1/44); After transplantation, CR rate was 71.7%(27/38), VGPR rate was 13.2% (5/38), PR rate was 13.2% (5/38), the progression of the disease (PD) rate 2.6% (1/38). The 5-year OS rate and PFS rate was 51.8% and 47.8%, the 10-year OS rate and PFS rate was 51.3% and 43.1%, respectively; the 5-year and 10-year cumulative disease relapse rate was 38.6% and 45.4%, the 5-year cumulative NRM rate was 25.0%. Acute GVHD rate was 38.6% (17/44) and grade 3-4 acute GVHD rate was 6.8% (3/44); chronic GVHD rate was 27.3% (12/44). Cox univariate and multivariate analysis showed that the use of bortezomib before transplantation (n HR = 3.461, 95% n CI 1.211-9.880, n P = 0.020) and post-transplant infection (n HR = 0.283, 95% n CI 0.098-0.819, n P = 0.020) were independent factors affecting OS after transplantation.n Conclusions:Allo-HSCT can overcome the high-risk factors of MM and is worth to try for high-risk MM patients. The use of bortezomib before transplantation and post-transplant infection can be important factors affecting OS after transplantation.