Kyle R A
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Semin Oncol. 1999 Feb;26(1):74-83.
Autologous stem cell transplantation is a reasonable approach for patients younger than 70 years and should be discussed with each patient before instituting alkylating agent therapy. Ideally, it should be done in a clinical trial. Although most patients relapse, it does provide a modest prolongation of survival. The major needs are an improved preparative regimen before transplantation and the removal of myeloma cells and, more importantly, their precursors from the peripheral blood. Conventional allogeneic transplantation is associated with too high a mortality rate at present and cannot be recommended. Efforts must be directed toward reducing transplant-related mortality by T-cell depletion or other means. The preparative regimen must be improved, because most patients relapse after transplantation. The use of dendritic cells and vaccines is an important area of research. The role of autologous transplantation in primary amyloidosis (AL) is indeterminate at present. Longer follow-up evaluation of patients who have undergone transplantation is needed. Patient selection is a critical aspect. Stem-cell transplantation should be performed in a clinical trial for primary AL.
自体干细胞移植对于70岁以下的患者是一种合理的治疗方法，在开始烷化剂治疗前应与每位患者进行讨论。理想情况下，应在临床试验中进行。虽然大多数患者会复发，但它确实能适度延长生存期。主要需求是改善移植前的预处理方案，去除骨髓瘤细胞，更重要的是，从外周血中去除其前体细胞。目前，传统的异基因移植死亡率过高，不推荐使用。必须通过T细胞清除或其他方法致力于降低移植相关死亡率。预处理方案必须改进，因为大多数患者移植后会复发。树突状细胞和疫苗的应用是一个重要的研究领域。自体移植在原发性淀粉样变性（AL）中的作用目前尚不确定。需要对接受移植的患者进行更长时间的随访评估。患者选择是一个关键方面。原发性AL的干细胞移植应在临床试验中进行。
