自体造血干细胞移植治疗多发性骨髓瘤的新进展

背景：自体造血干细胞移植是治疗多发性骨髓瘤的有效手段,诱导化疗后行自体造血干细胞移植已成为多发性骨髓瘤的标准治疗方案,多单位、多中心进行了大规模的研究报道。如何减少药物毒副反应、移植相关并发症及改善长期生存是目前关注的重点。目的：综述自体造血干细胞移植治疗多发性骨髓瘤的新进展。方法：应用计算机检索2006年1月至2012年11月PubMed、CNKI数据库、维普数据库、万方数据库、free medicaljournals.com网络资源关于自体造血干细胞移植治疗多发性骨髓瘤的文献。英文检索词“Autologous hematopoietic stem cell transplantation, multiple myeloma”;中文检索词“自体造血干细胞移植,多发性骨髓瘤”。选中相关性强的46篇进行综述。结果与结论：大剂量化疗联合自体造血干细胞移植治疗多发性骨髓瘤的疗效优于传统化疗。但单次自体造血干细胞移植后仍有许多患者不能得到很好的缓解,疾病最终难免复发;异基因造血干细胞移植受到供体来源限制,且治疗相关病死率高,运用受到限制。因此目前的新发展方向包括：在单次自体造血干细胞移植的基础上进行2次自体造血干细胞移植、自体联合减低预处理强度的异体移植以及药物巩固维持治疗。新型药物蛋白酶体抑制剂及免疫调节剂在诱导缓解、预处理、尤其是巩固维持阶段的使用,使多发性骨髓瘤的治疗总体反应率及长期生存得到显著改善。

New progress of autologous hematopoietic stem cell transplantation in the treatment of multiple myeloma

BACKGROUND:Autologous hematopoietic stem cell transplantation is an effective treatment for multiple myeloma. After chemotherapy, autologous hematopoietic stem cell transplantation becomes a standard therapeutic regimen for multipla myeloma, and numerous units and centers have reported that. How to reduce toxic and adverse reactions of the drugs, transplantation-related complications and improvement of long-term survival have been present foci. OBJECTIVE:To summarize the new progress of autologous hematopoietic stem cell transplantation in the treatment of multiple myeloma. METHODS:We retrieved PubMed and China National Knowledge Infrastructure database, Vip database, Wanfang database, free medicaljournals.com source for articles published from January 2006 to November 2012 concerning autologous hematopoietic stem cell transplantation in the treatment of multiple myeloma. The key words were “autologous hematopoietic stem cell transplantation, multiple myeloma”. A total of 46 articles were included. RESULTS AND CONCLUSION:Large-dose chemotherapy combined with autologous hematopoietic stem cell transplantation for multiple myeloma obtained better outcomes compared with the traditional chemotherapy. However, many patients could not relieve after single autologous hematopoietic stem cell transplantation, and the disease recurred finally. Allogeneic hematopoietic stem cell transplantation was limited by donor source, and treatment-associated fatality rate was high, so its use was confined. Therefore, present new development direction included twice autologous hematopoietic stem cell transplantation, autologous transplantation combined with allogeneic transplantation with reduced-intensity conditioning regimens as well as drug on the basis of single autologous hematopoietic stem cell transplantation. Novel drug proteasomes inhibitor and immunomodulator in inducer remission, pretreatment and sustaining stages obviously improved total reaction rate of multiple myeloma therapy and long-term survival.