Adult Bone Marrow Transplantation Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York 10065, USA.
Curr Opin Oncol. 2012 Nov;24(6):720-6. doi: 10.1097/CCO.0b013e328358f619.
Despite the curative potential of allogeneic hematopoietic stem cell transplantation (allo HSCT) for patients with multiple myeloma, and reduction of transplant-related mortality with nonmyeloablative transplant approaches, rates of acute and chronic graft-versus-host disease and disease progression remain high. It is unclear if nonmyeloablative transplants are more effective than autologous (auto). Novel promising drugs and maintenance treatment strategies following auto SCT may also delay allo transplantation. In this review, we summarize the emerging data on allo HSCT and provide suggestions for its optimal role in the treatment of myeloma.
Large cooperative group studies comparing allo HSCT with auto SCT as frontline therapy have been performed with reduced intensity conditioning regimens using unmanipulated peripheral blood stem cells from human leukocyte antigen (HLA)-compatible donors and standard calcineurin inhibitor graft-versus-host disease prophylaxis. Two recent reports show conflicting data. Although the Blood and Marrow Transplant Clinical Trials Network 0102 study demonstrated no progression-free or overall survival advantage at 3 years, a European study demonstrated superior 5-year outcome after auto/HLA-matched sibling allo HSCT compared with tandem auto SCT in previously untreated multiple myeloma patients. The advent of maintenance therapy could potentially improve outcomes of both transplant types.
High rates of acute and chronic graft-versus-host disease currently limit the implementation of nonmyeloablative allo HSCT. Novel approaches are required so that patients with myeloma can undergo allo HSCT before resistance develops to standard drug combinations.
尽管异基因造血干细胞移植（allo HSCT）对多发性骨髓瘤患者具有治愈潜力，且非清髓性移植方法降低了与移植相关的死亡率，但急性和慢性移植物抗宿主病及疾病进展的发生率仍然很高。目前尚不清楚非清髓性移植是否比自体（auto）更有效。新型有前途的药物和自体 SCT 后维持治疗策略也可能延迟 allo 移植。在这篇综述中，我们总结了 allo HSCT 的最新数据，并就其在多发性骨髓瘤治疗中的最佳作用提出了建议。
已经进行了大型合作组研究，比较了 allo HSCT 与 auto SCT 作为一线治疗，采用非清髓性预处理方案，使用未经处理的人白细胞抗原（HLA）相容供者外周血造血干细胞和标准钙调神经磷酸酶抑制剂移植物抗宿主病预防。最近的两项报告显示出相互矛盾的数据。尽管血液和骨髓移植临床研究网络 0102 研究显示 3 年时无无进展生存期或总生存期优势，但一项欧洲研究表明，与以前未经治疗的多发性骨髓瘤患者的串联自体 SCT 相比，自体/HLA 匹配同胞 allo HSCT 后 5 年的结果更好。维持治疗的出现可能会改善两种移植类型的结果。
目前急性和慢性移植物抗宿主病的高发生率限制了非清髓性 allo HSCT 的实施。需要新的方法，以便在多发性骨髓瘤患者对标准药物组合产生耐药性之前，可以进行 allo HSCT。
