Department of Hematology and Bone Marrow Transplant Unit, Institut of Hematology and Oncology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Blood. 2010 May 6;115(18):3655-63. doi: 10.1182/blood-2009-08-238196. Epub 2010 Mar 4.
Autologous stem cell transplantation (ASCT) is considered the gold standard in the frontline therapy of younger patients with multiple myeloma because it results in higher complete remission (CR) rates and longer event-free survival than conventional chemotherapy. The greatest benefit from ASCT is obtained in patients achieving CR after transplantation, the likelihood of CR being associated with the M-protein size at the time of transplantation. The incorporation of novel agents results in higher pre- and posttransplantation CR rates. Induction with bortezomib-containing regimens is encouraging in patients with poor-risk cytogenetics. However, longer follow-up is required to assess the impact of this increased CR on long-term survival. The results of posttransplantation consolidation/maintenance with new drugs are encouraging. All this indicates that, in the era of novel agents, high-dose therapy should be optimized rather than replaced. Because of its high transplantation-related mortality, myeloablative allografting has been generally replaced by reduced-intensity conditioning (reduced intensity conditioning allogeneic transplantation). The best results are achieved after a debulky ASCT, with a progression-free survival plateau of 25% to 30% beyond 6 years from reduced intensity conditioning allogeneic transplantation. The development of novel reduced-intensity preparative regimens and peri- and posttransplantation strategies aimed at minimizing graft-versus-host disease, and enhancing the graft-versus-myeloma effect are key issues.
自体干细胞移植（ASCT）被认为是年轻多发性骨髓瘤患者一线治疗的金标准，因为它比常规化疗导致更高的完全缓解（CR）率和更长的无事件生存。ASCT 最大的获益来自于移植后获得 CR 的患者，CR 的可能性与移植时 M 蛋白的大小有关。新型药物的加入导致了更高的移植前和移植后 CR 率。对于细胞遗传学不良风险的患者，含硼替佐米的方案诱导令人鼓舞。然而，需要更长的随访时间来评估这种增加的 CR 对长期生存的影响。新型药物移植后巩固/维持的结果令人鼓舞。所有这些都表明，在新型药物时代，应该优化大剂量治疗，而不是替代它。由于其较高的移植相关死亡率，清髓性异基因移植已普遍被强度降低的预处理方案（强度降低的预处理异基因移植）所取代。在进行大容量 ASCT 后，最佳结果是实现无进展生存，在强度降低的预处理异基因移植后 6 年以上，无进展生存的平台期达到 25%至 30%。新型强度降低的预处理方案的发展以及旨在最小化移植物抗宿主病并增强移植物抗骨髓瘤效应的移植前后策略是关键问题。
