多发性骨髓瘤的造血干细胞移植.pptx

为什么要移植？;不同时间段内多发性骨髓瘤主要年龄组患者的10年生存率;P10 -5 P=0.07 ;Barlogie B, et al. Cancer. 2008;113:355–359. . ;以新药为基础的诱导方案的疗效;ASCT能进一步提高新药诱导后的疗效;;;以硼替佐米为基础的诱导方案;移植的时机目前倾向于作为巩固治疗在疾病早期进行，避免在疾病复发时一般情况差、肾功能不全、年龄增加、过多骨骼破坏以及发生MDS的高风险。 ;病人的年龄多限定在65岁以下，但也有超出该年龄病人的报道。 肾功能不全不是移植的禁忌症，一般可将马法兰的剂量调整至140mg/m2;如病人有低蛋白血症，可将马法兰的剂量进一步调整至70-100mg/m2。 ;;小结; 干细胞动员的问题;High rate of stem cell mobilization failure after thalidomide and oral cyclophosphamide induction therapy for multiple myeloma HW Auner, L Mazzarella, L Cook, R Szydlo, F Saltarelli, J Pavlu, M Bua, C Giles, JF Apperley and A Rahemtulla Department of Haematology Hammersmith Hospital Imperial College Healthcare NHS Trust, London, UK;第16页/共76页;Figure 1 Induction therapy with CY and thalidomide with dexamethasone (CTD) impairs the stem cell collection yield and increases the number of apheresis procedures required. (a) Bars show the median number of CD34tcells/kg collected overall, on the first apheresis day, and per apheresis procedure. (b) Bars show the percentage of patients undergoing X2 apheresis procedures.;第18页/共76页;预 处 理;How to improve the efficacy of condition regimens;BU and CY as conditioning regimen for autologous transplant in patients with multiple myeloma G Talamo, DF Claxton, DW Dougherty, CW Ehmann, J Sivik, JJ Drabick and W Rybka Bone Marrow Transplant Program, Penn State Milton S Hershey Cancer Institute, Hershey, PA, USA;第22页/共76页;Figure 1 OS of multiple myeloma patients treated with the BU/CY regimen and ASCT (n79), from day 0 of ASCT. Thin lines indicate the 95% confidence interval.;移植后的巩固与维持治疗;2009 ASH Abstract 351;Study Design;Patient Characteristics;Best Response;PFS in High-risk Cytogenetics*;Br J Haematol,2008,140:625–634.;;第32页/共76页;第33页/共76页; Mel 干细胞回输 G-CSF V V V V;Consolidation with Bortezomib+Thalidomide+Dex;第36页/共76页;清髓性异基因移植;Overall and event-free survival are not improved by the use of myeloablative therapy following intensified chemotherapy