多发性骨髓瘤移植首都医科大学附属北京朝阳医院精品课件陈文明.pptVIP

为什么要移植？ 小结 患者的生存与缓解程度有关 化疗可以提高缓解率及缓解程度 二次移植优于单次移植 新药的应用可以进一步提高疗效 早期与晚期移植的疗效相似 干细胞动员的问题 预 处 理 清髓性异基因移植 序贯自体-非清髓移植 异基因移植的优势 浆细胞白细胞的移植 Br J Haematol,2008,140:625–634. Mel 干细胞回输 G-CSF V V V V -6 -3 -2 0 +1 +4 +7 V= 万珂 1.0-1.3mg/m2 Mel = 马法兰 200mg/m2 万珂-马法兰用于ASCT预处理的研究 缓解率 CR = 31% !，VGPR = 46% CR+VGPR=77% （历史对照：常规HDM预处理，ASCT后的CR+VGPR=40~50%） Rousselet al. Hematology 2006;91 (suppl .1),p98.EHA 2006,abs 0233# Consolidation with Bortezomib+Thalidomide+Dex Patients(n=40) with CR or VGPR following ASCT Treatments: 4 consolidation cycles of Btz-Thal-Dex Results: --36% converted from VGPR to CR --Six patients(15%) achieved Molecular Remission Overall and event-free survival are not improved by the use of myeloablative therapy following intensified chemotherapy in previously untreated patients with multiple myeloma: a prospective randomized phase 3 study Christine M. Segeren, Pieter Sonneveld, Bronno van der Holt, et al. Erasmus Medical Center Rotterdam (Erasmus MC) and University Medical Center Utrecht (UMCU) for the Dutch-Belgian Hemato-Oncology Cooperative Study Group (HOVON), The Netherlands BLOOD, 2003 , 101( 6):2144-51 TTP OS Myeloablative BMT 40% (3) 55% (3) NR 35% (3) 55% (3) 57% (3) 60% 60% 54% 46% 30% 37% 334 (27) BM ’83-‘93 356 (24) BM ’94-‘98 133 (26) PBSC ’94-‘98 Gahrton 20% (4.5) 24% (4.5) 36% 43% 80 (71) Bensinger 55% (5) 28% (7) 44% 41% 162 (46) Gahrton PFS (f/u years) OS (f/u years) CR TRM N (% chemo-refractory) Author Overall Survival Years Proportion 0 2 4 6 8 10 12 0.0 0.2 0.4 0.6 0.8 1.0 Allogeneic Autologous p=0.006 Causes of Treatment Failure Cumulative Incidence of Relapse Years Cumulative Incidence 0 2 4 6 8 10 12 0.0 0.2 0.4 0.6 0.8 1.0 Autologous Allogeneic p=0.02 Allogeneic SCT Advangtages Stem cells Non-contaminated No damage GVM effect Disadvantages Trx related