Devarakonda Srinivas, Efebera Yvonne, Sharma Nidhi
Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, Columbus, OH 43210, USA.
Cancers (Basel). 2021 Feb 18;13(4):863. doi: 10.3390/cancers13040863.
Autologous stem cell transplantation (auto-SCT) has been the standard of care in eligible newly diagnosed multiple myeloma (MM) patients. Outcomes of patients with MM have improved significantly due to the advent of several novel drugs. Upfront use of these drugs in induction therapy has significantly increased the rate and depth of responses that have translated into longer remission and survival. This has now raised a debate regarding the role and relevance of auto-SCT in the management of myeloma. However, clinical trials have confirmed the utility of auto-SCT even in the era of novel drugs. Tandem auto-SCT followed by maintenance has shown a progression-free survival (PFS) benefit in high-risk MM, and hence can be considered in young and fit patients with high-risk disease. Auto-SCT has the advantages of resetting the bone marrow microenvironment, short-lived toxicity compared to the long-term physical and financial toxicities of continued chemotherapy in the absence of SCT, very low transplant-related mortality (TRM) in high volume centers, and providing longer disease-free survival when followed by maintenance therapy. Allogeneic SCT is one potentially curative option for MM, albeit with an increased risk of death due to high TRM. Strategies to modulate the graft-versus-host disease (GVHD) while maintaining or improving the graft-versus-myeloma (GVM) effect could place allogeneic SCT back in the treatment armamentarium of MM.
自体干细胞移植（auto-SCT）一直是符合条件的新诊断多发性骨髓瘤（MM）患者的标准治疗方法。由于几种新型药物的出现，MM患者的治疗结果有了显著改善。在诱导治疗中预先使用这些药物显著提高了缓解率和缓解深度，从而转化为更长的缓解期和生存期。这引发了关于auto-SCT在骨髓瘤治疗中的作用和相关性的争论。然而，临床试验已经证实了auto-SCT即使在新型药物时代的效用。序贯自体干细胞移植后进行维持治疗已显示出对高危MM患者有无进展生存期（PFS）获益，因此对于年轻且身体状况良好的高危疾病患者可以考虑采用。auto-SCT具有重置骨髓微环境的优势，与在未进行SCT的情况下持续化疗的长期身体和经济毒性相比，其毒性持续时间较短，在大容量中心移植相关死亡率（TRM）非常低，并且在进行维持治疗后可提供更长的无病生存期。异基因造血干细胞移植（Allogeneic SCT）是MM的一种潜在治愈选择，尽管由于高TRM导致死亡风险增加。在维持或改善移植物抗骨髓瘤（GVM）效应的同时调节移植物抗宿主病（GVHD）的策略可能会使异基因造血干细胞移植重新成为MM治疗手段之一。
