造血干细胞移植治疗多发性骨髓瘤的研究

Hemopoietic Stem Cell Transplantation for Multiple Myeloma——Review

在常规化疗无明显改善多发性骨髓瘤 (MM )无病生存率和总的生存率的情况下 ,造血干细胞移植在近十多年来广泛应用于MM治疗。自体外周血干细胞移植曾广泛用于MM治疗 ,可提高患者的缓解率 ,并延长生存期 ,但复发率高影响了其疗效。二次移植可再次提高患者的缓解率 ,但需进一步评价。异基因干细胞移植存在移植物抗骨髓瘤效应 ,可使 1/ 3的患者达到分子学缓解 ,但移植相关死亡率高限制了其应用。正在临床广泛研究的非清髓性干细胞移植的移植相关死亡率低 ,存在移植物抗骨髓瘤效应 ,这可弥补以上不足。

In the absence of significant improvement of disease-free survival (DFS) and overall survival (OS) by conventional chemotherapy,high dose chemotherapy in combination with hematopoietic stem cell transplantation has been increasingly used in the past decade for multiple myeloma (MM). Autologous stem cell transplantation (ASCT) was one of the most widely used methods in the treatment of MM. The patients who received ASCT may achieve a very good remission rate. ASCT may improve DFS but its application in clinic was limited by its high relapse rate. Tandem transplantation was feasible by its significant improvement of complete remission,but needed further evaluation. Allogeneic stem cell transplantation (Allo-SCT) has graft-versus-myeloma (GVM) effect, and provides molecular remission in about one third patients. It can only be offered to a small proportion of patients because of its high transplant-related mortality (TRM). Non-myeloablative transplantation is an attractive alternative tested currently in frontline treatment because of its GVM effect and low TRM.