造血干细胞移植治疗难治性多发性骨髓瘤

Hematopoietic stem cells transplantation for the treatment of refractory multiple myeloma

背景:近年来,多发性骨髓瘤发病率有所增长,然而治疗相当棘手。造血干细胞移植技术不断改进,新的药物应用于临床,以及移植联合新药治疗,为患者带来新的希望。目的:总结近年来造血干细胞移植及其与新药联用方案治疗难治性多发性骨髓瘤的新进展。方法:应用计算机检索PubMed、ISI平台BP+Medline数据库及万方、维普数据库1990年1月至2012年4月有关造血干细胞移植及免疫调节剂、蛋白酶体抑制剂联合移植的文献报道,排除陈旧的、内容重复的文章。结果与结论:检索及筛选后保存22篇中英文文献,并对其进行分析,得出造血干细胞移植以及联合新药的治疗策略使得大剂量化疗和自体干细胞移植治疗的效果得到显著改善。移植前加用新药诱导和移植后用新药维持治疗可以延缓进展期,提高总体生存率。异基因造血干细胞移植治疗可以使多发性骨髓瘤患者获得长期的分子生物学缓解并治愈。多种治疗方法的组合及优缺点比较,可更好的为临床医师在实践中根据患者实际情况进行决策,最大程度满足患者的需要。

BACKGROUND： In recent years, the morbidity of multiple myeloma is increased; however, this disease cannot be cured now. With the improvements in hematopoietic stem cells transplantation technology and clinical application of new drugs, as well as cell transplantation treatment combined with new drug application, multiple myeloma patients will have new hope in their lives.OBJECTIVE： To summarize the progress of refractory multiple myeloma treatment by hematopoietic stem cells transplantation combined with new drug therapy in recent years.METHODS： A computer-based search was performed on PubMed database, ISI platform BP＋Medline database, Wanfang database and VIP database for articles describing hematopoietic stem cells transplantation and immunoregulant, protease inhibitors combined cell transplantation published during January 1990-April 2012. Articles with obsolete and repeated contents were rejected.RESULTS AND CONCLUSION： A total of 22 articles in Chinese and English were obtained after retrieval and screening. Analysis of retrieved articles shows that hematopoietic stem cells transplantation combined with new drug treatment strategy can greatly improve the effects of high-dose chemotherapy and autologous stem cell transplantation treatment. Pre-transplantation induction with new drug application and post-transplantation maintenance with new drug can delay the progression and enhance the overall survival rates. Allogeneic hematopoietic stem cell transplantation therapy will achieve long-term molecular biological relief and therapeutic effects in multiple myeloma patients. The combination of a variety of treatment methods and the comparison between the advantages and disadvantages can help the clinicians to make better decision-making in practice according to real situation of the patients, and can satisfy the needs of patients.