Wang Xueting, Cui Yushan, Wang Yaomei, Fang Baijun
Department of Hematology, Henan Institute of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
Ann Hematol. 2025 Sep 15. doi: 10.1007/s00277-025-06563-z.
Multiple myeloma (MM) is a heterogeneous and relapse-prone hematologic malignancy that remains incurable. For newly diagnosed patients aged 70 years or younger, who are eligible for transplantation, autologous hematopoietic stem cell transplantation (auto-HSCT) is the preferred first-line treatment. In patients with high-risk multiple myeloma (HRMM), some studies have demonstrated that tandem auto-HSCT provides notable benefits over single auto-HSCT, particularly in extending progression-free survival (PFS) and overall survival (OS). Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) currently offers the only potential for long-term cure in MM, its application is limited by high transplant-related mortality (TRM) and the risk of graft-versus-host disease (GVHD). In recent years, the emergence of novel therapies, including proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and chimeric antigen receptor T-cell (CAR-T) therapy, has posed new challenges to the role of tandem auto-HSCT in MM treatment. This review aims to critically examine the efficacy differences between tandem and single auto-HSCT, and sequential allo-HSCT following auto-HSCT. Furthermore, it will rigorously evaluate the role and challenges of tandem auto-HSCT within the evolving therapeutic landscape.
多发性骨髓瘤（MM）是一种异质性且易于复发的血液系统恶性肿瘤，目前仍无法治愈。对于年龄在70岁及以下且适合移植的新诊断患者，自体造血干细胞移植（auto-HSCT）是首选的一线治疗方法。在高危多发性骨髓瘤（HRMM）患者中，一些研究表明，与单次auto-HSCT相比，序贯auto-HSCT具有显著优势，尤其是在延长无进展生存期（PFS）和总生存期（OS）方面。尽管同种异体造血干细胞移植（allo-HSCT）目前是MM唯一具有长期治愈潜力的方法，但其应用受到高移植相关死亡率（TRM）和移植物抗宿主病（GVHD）风险的限制。近年来，包括蛋白酶体抑制剂、免疫调节药物、单克隆抗体和嵌合抗原受体T细胞（CAR-T）疗法在内的新型疗法的出现，给序贯auto-HSCT在MM治疗中的作用带来了新的挑战。本综述旨在严格审视序贯和单次auto-HSCT以及auto-HSCT后序贯allo-HSCT之间的疗效差异。此外，它将严格评估序贯auto-HSCT在不断演变的治疗格局中的作用和挑战。
