Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
Clin Lymphoma Myeloma Leuk. 2011 Jun;11(3):247-52. doi: 10.1016/j.clml.2011.03.010. Epub 2011 Apr 20.
Reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) can result in reliable donor engraftment, relatively low treatment-related mortality, and sustained remissions in the treatment of multiple myeloma. However, substantial cytoreduction pre-allografting is often necessary because of a variable graft-versus-myeloma effect. The use of RIC allogeneic HSCT immediately after autologous HSCT provides a temporal separation between tumor reduction by high-dose chemotherapy and the graft-versus-myeloma effect. There are currently a number of prospective trials attempting to address the issue of whether this strategy leads to decreases in relapse and/or improvement in overall survival as compared with double autologous transplants. Unfortunately, similar to autografting, relapse remains the major cause of treatment failure after RIC allogeneic HSCT. To improve treatment results with allografting, consideration should be given to incorporating immunomodulatory drugs and targeted treatments to enhance pretransplantation remission status, as posttransplantation maintenance therapy, or in combination with donor lymphocyte infusions for refractory or relapsed disease. Studies exploring these strategies are ongoing.
降低强度预处理（RIC）异基因造血干细胞移植（HSCT）可实现可靠的供者植入、相对较低的治疗相关死亡率，并可持久缓解多发性骨髓瘤。然而，由于移植物抗骨髓瘤效应的变异性，通常需要在移植前进行大量细胞减灭。在自体 HSCT 后立即进行 RIC 异基因 HSCT 可在大剂量化疗减瘤和移植物抗骨髓瘤效应之间实现时间分离。目前有许多前瞻性试验试图解决这一策略是否会导致复发率降低和/或总生存率提高的问题，与双自体移植相比。不幸的是，与自体移植一样，复发仍然是 RIC 异基因 HSCT 后治疗失败的主要原因。为了改善移植治疗的结果，应考虑将免疫调节药物和靶向治疗纳入其中，以增强移植前的缓解状态，作为移植后维持治疗，或与供者淋巴细胞输注联合用于难治性或复发性疾病。目前正在进行探索这些策略的研究。
