Shimazaki Chihiro
Division of Hematology, Department of Medicine, Kyoto Prefectural University of Medicine.
Nihon Rinsho. 2007 Dec;65(12):2338-44.
The role of stem cell transplantation in the treatment of multiple myeloma (MM) is described. High-dose chemotherapy (HDT) followed by autologous stem cell transplantation (SCT) is routinely recommended for most patients with newly diagnosed MM under 65 years of age. However, recently published meta-analysis of randomized controlled trials indicated PFS benefit but not OS benefit for HDT with autologous SCT performed early in MM. Tandem autologous SCT is superior to single transplantation in terms of event-free survival. Survival in recipients of autologous SCT followed by reduced-intensity conditioning allogeneic transplantation is superior to that in recipients of tandem autologous SCT. Recently developed new drugs including thalidomide, lenalidomide or bortezomib in combination with SCT might improve survival of myeloma patients.
本文描述了干细胞移植在多发性骨髓瘤(MM)治疗中的作用。对于大多数65岁以下新诊断的MM患者,常规推荐先进行大剂量化疗(HDT),然后进行自体干细胞移植(SCT)。然而,最近发表的随机对照试验的荟萃分析表明,MM早期进行HDT联合自体SCT可使无进展生存期(PFS)获益,但总生存期(OS)无获益。在无事件生存期方面,序贯自体SCT优于单次移植。自体SCT后接受减低剂量预处理的异基因移植患者的生存期优于序贯自体SCT患者。最近开发的包括沙利度胺、来那度胺或硼替佐米在内的新药与SCT联合使用可能会提高骨髓瘤患者的生存率。