摘要
自体骨髓移植治疗多发性骨髓瘤（MM）始于20世纪80年代。随着自体外周血干细胞移植替代骨髓移植，大大提高了自体造血干细胞移植治疗MM的可行性。多个历史对照和随机临床研究显示自体造血干细胞移植较传统化疗显著地提高MM患者治疗的反应率、完全缓解率、无事件生存和（或）总生存，而治疗反应程度与生存相关。自体造血干细胞移植在欧美国家已成为年轻、适合（年龄≤65岁、肾功能正常和一般状况良好）的MM患者的一线标准治疗。同时已证实美法仑200mg／m^2是预处理的最佳方案。双次移植有可能进一步提高治疗反应、无事件生存和（或）总生存，特别是对首次移植后未获得非常好的部分缓解或接近完全缓解的患者。近10年来，随着免疫调节药物沙利度胺及其衍生物和蛋白酶体抑制剂硼替佐米等新型抗MM药物的应用，显著提高了化疗的反应率和缓解率。目前尚无证据显示新药可以替代自体造血干细胞移植，但这些药物在移植前后的应用，进一步提高了MM的疗效。
Autologous bone marrow transplantation was introduced in the treatment of multiple myeloma （MM） in the 1980 s. The use of peripheral blood stem cells instead of bone marrow has markedly improved feasibility. Since most historical control and randomized studies have shown the superiority of autologous stem cell transplantation（ASCT） compared to conventional chemotherapy, ASCT is considered the standard of care for patients up to 65 years of age without renal failure with MM.Survival appears to be significantly related to the magnitude of response.The optimal preparative regimen given prior to ASCT is melphalan 200 mg/m2. And tandem or double ASCT explored to improve outcomes further, particularly for those patients who do not attain very good PR or near CR with the first ASCT. In the past decade, thalidomide, bortezomib, and lenalidomide emerged as effective new agents for treatment of myeloma, producing spectacular result in combination with other known agents in terms of response rate, CR rate, progression-free survival（PFS）, and overall survival（OS）. But now it is premature to use new agents to replace ASCT as the front-line MM treatment paradigm. The available evidence has suggested that the sequential incorporating use of autografts and novel agents would be superior to the use of novel agents alone without ASCT.
出处
《白血病．淋巴瘤》
CAS
2009年第9期519-522,共4页
Journal of Leukemia & Lymphoma
关键词
多发性骨髓瘤
造血干细胞移植
自体
Multiple myeloma
Stem cell transplantation
Autologous
