[临床医学]异基因造血干细胞移植治疗多发性骨髓瘤.ppt
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1、Allogeneic haematopoietic cell transplantation for multiple myeloma,The allogeneic transplant has the advantage over the autologous transplant The graft does not contain tumor cells and the potential for a graft versus myeloma (GvM) effect,Bone marrow transplantation in three patients with multiple
2、myeloma Gahrton G, Ringdn O, Lnnqvist B, Lindquist R, Ljungman P.,Acta Med Scand 1986;219(5):523-7.,瑞典卡罗林斯卡医学院 1983,Myeloablative conditioning,Three patients with multiple myeloma received bone marrow grafts from HLA-identical sibling donors One of the patients, with IgA kappa myeloma, refractory to
3、 alkeran-prednisone therapy, is well and still without sign of disease 26 months post transplantation A second patient with Bence-Jones kappa myeloma is well, and skeletal pain and Bence-Jones proteinuria has disappeared 2 months after transplantation. A third patient with IgG-lambda myeloma died of
4、 effusive pericarditis shortly after transplantation.,Acta Med Scand 1986;219(5):523-7,Conclusion,Bone marrow transplantation may be indicated in a selective group of patients with multiple myeloma,Acta Med Scand 1986;219(5):523-7,Out of 690 allogenetic matched sibling donor transplants for MM 344 w
5、ere performed during the period 1983-93(all with BM ) group 1 356 during 1994-98 (223 with BM group 2 and 133 with PB group 3),the median age at transplantation of patients in group 1 was 43 years (range 21-62) In group 2 ,44 years (range 18_57) and in group 3, 46 years (range 25_60),TBI+CY tended t
6、o be more commonly used in group 1(37%) and 2 (39%) than in group 3 (27%) Melphalan containing regimes tended to be morely used in group 3 Melphalan or Busulphan + CY rarely,Conditiong regime,Engraftment,GVHD,Treatment related mortality,Treatment related mortality,Relapse rate,Relapse rate,Survival,
7、Survival,Progression free survival,PFS was significantly better for group 2than for group 1(P0.0001) With no significantly difference between group 2 and 3,Cause of death,75% in group 1,36% in group 2 ,33 % in group 3 GVHD Fungal ARDS Organ failure,Cause of death,the study shows that the improvement
8、 is entirely a result of a lower TRM during the latest 5-years period aGVHD has no changed during this peroid There was significant difference in deaths caused by IP and bacterial and fungalinfection,Conditioning regime,TBI+Melphalan has not previrous been Shown to be superior to TBI+CY in this stud
9、y,conclusion,Survival 3060% Treatment related mortality 30%,Myeloablative allogeneic versus autologous transplantation,during the years 1983 to 1994 189 myeloma patients who underwent allo-BMT with an HLA-identical sibling donor were compared retrospectively with an equal number of patients who rece
10、ived a single autologous bone marrow or blood stem cell graft And the ASCT patients were transplanted from 1986 to 1994,conclusion The overall survival was significantly better for ASCT than for allo-BMT, with a median survival of 34 months and 18 months, respectively (P = .001), The main reason for
11、 the poorer survival in allo-BMT patients was higher TRM (41% v 13% for ASCT, P = .0001), which was not compensated for by a lower rate of relapse and progression,conclusion However, in patients alive at 1 year posttransplant, there was a trend for better long-term survival (P = .O9) and significant
12、ly better progression-free survival (P = .02) for allo-BMT as compared with ASCT We conclude that the median survival is superior for ASCT However, allo-BMT has a lower relapse rate, which results in a similar long-term outcome for both approaches, but a longer follow-up is needed to assess the fina
13、l outcome,Reduced-intensity conditioning allogeneic transplantation,The Allo-RIC was introduced in an attempt to decrease the transplant-related toxicity while retaining the beneficial GvM effect 1998 begin clinical study,19982003 We report the outcome of 229 patients who received an allograft for m
14、yeloma with reduced-intensity conditioning (RIC) regimens from 33 centers within the EBMT.,With a median follow-up of 28 months, 115 patients are alive(range, 1-53 months) The estimated overall survival at 3 years is 40.6% (CI, 33%-49%) The treatment-related mortalities at day 100, 1 year,and 2 year
15、s were 10%, 22%, and 26%, respectively. The cumulative probability of the progression-free survival was 21.3% (CI, 15%-29%) at 3years,Conclusion While RIC is feasible, heavily pretreated patients and patients with progressive disease do not benefit,RIC vs MAC,Data were available on a total of 516 pa
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- 临床医学 基因 造血 干细胞 移植 治疗 多发性 骨髓瘤
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