Giralt S, Bensinger W
Department of Medicine, Memorial Sloan-Kettering Cancer Center , New York, NY, USA.
Department of Medicine, University of Washington Fred Hutchinson Cancer Research Center , Seattle, WA, USA.
Leuk Suppl. 2013 May;2(Suppl 1):S10-4. doi: 10.1038/leusup.2013.3. Epub 2013 May 8.
Stem cell transplantation (SCT) has been used in the treatment of multiple myeloma (MM) for decades and has become a standard of care for newly diagnosed MM patients. However, several important questions remain regarding the optimal use of SCT, particularly in light of the many recent advances in the treatment of MM. Bortezomib-based therapy or, in some cases, lenalidomide-based therapy should be considered as an induction therapy in transplantation-eligible patients. Efforts to improve upon the efficacy and safety of standard transplantation regimens (that is, high-dose melphalan) are also underway. Most published studies on the use of tandem autologous SCT were conducted before the advent of novel agents, such as thalidomide, lenalidomide and bortezomib, making it difficult to establish the current role of tandem SCT. Allogeneic SCT continues to be evaluated in clinical trials, and may have an important role in the treatment of transplantation-eligible patients with suitable donors. Post-transplantation consolidation and maintenance therapy using novel agents should be considered to improve outcomes in patients who fail to achieve a complete response following SCT. Patients in remission should be advised that continued therapy has been shown to prolong remission, improve quality of life and extend survival. Additional data on the optimal approach to post-transplantation therapy are needed. New strategies in development aimed at improving patient selection, safety and efficacy of SCT are likely to improve future outcomes.
几十年来，干细胞移植（SCT）一直用于治疗多发性骨髓瘤（MM），并已成为新诊断MM患者的护理标准。然而，关于SCT的最佳使用仍存在几个重要问题，特别是鉴于MM治疗方面最近取得的许多进展。对于适合移植的患者，基于硼替佐米的疗法或在某些情况下基于来那度胺的疗法应被视为诱导疗法。提高标准移植方案（即大剂量美法仑）疗效和安全性的努力也在进行中。大多数已发表的关于使用串联自体SCT的研究是在沙利度胺、来那度胺和硼替佐米等新型药物出现之前进行的，因此难以确定串联SCT目前的作用。异基因SCT仍在临床试验中进行评估，对于有合适供体的适合移植的患者，可能在治疗中发挥重要作用。应考虑使用新型药物进行移植后巩固和维持治疗，以改善SCT后未达到完全缓解的患者的预后。应告知缓解期患者，持续治疗已被证明可延长缓解期、改善生活质量并延长生存期。需要更多关于移植后治疗最佳方法的数据。正在开发的旨在改善患者选择、SCT安全性和疗效的新策略可能会改善未来的治疗结果。
