异基因造血干细胞移植治疗多发性骨髓瘤.ppt

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1、AllogeneichaematopoieticcelltransplantationformultiplemyelomaTheallogeneictransplanthastheadvantageovertheautologoustransplantThegraftdoesnotcontaintumorcellsandthepotentialforagraftversusmyeloma(GvM)effectBonemarrowtransplantationinthreepatientswithmultiplemyelom

2、aGahrtonG,RingdénO,LönnqvistB,LindquistR,LjungmanP.ActaMedScand1986;219(5):523-7.瑞典卡罗林斯卡医学院1983MyeloablativeconditioningThreepatientswithmultiplemyelomareceivedbonemarrowgraftsfromHLA-identicalsiblingdonorsOneofthepatients,withIgAkappamyeloma,refractorytoalkeran-p

3、rednisonetherapy,iswellandstillwithoutsignofdisease26monthsposttransplantationAsecondpatientwithBence-Joneskappamyelomaiswell,andskeletalpainandBence-Jonesproteinuriahasdisappeared2monthsaftertransplantation.AthirdpatientwithIgG-lambdamyelomadiedofeffusivepericard

4、itisshortlyaftertransplantation.ActaMedScand1986;219(5):523-7ConclusionBonemarrowtransplantationmaybeindicatedinaselectivegroupofpatientswithmultiplemyelomaActaMedScand1986;219(5):523-7Outof690allogeneticmatchedsiblingdonortransplantsforMM344wereperformedduringthe

5、period1983-93(allwithBM)[group1]356during1994-98(223withBMgroup2and133withPBgroup3)themedianageattransplantationofpatientsingroup1was43years(range21-62)Ingroup2,44years(range18_57)andingroup3,46years(range25_60)TBI+CYtendedtobemorecommonlyusedingroup1(37%)and2(39%

6、)thaningroup3(27%)Melphalancontainingregimestendedtobemorelyusedingroup3MelphalanorBusulphan+CYrarelyConditiongregimeEngraftmentGVHDTreatment–relatedmortalityTreatment–relatedmortalityRelapserateRelapserateSurvivalSurvivalProgression–freesurvivalPFSwassignificantl

7、ybetterforgroup2thanforgroup1(P＜0.0001)Withnosignificantlydifferencebetweengroup2and3Causeofdeath75%ingroup1,36%ingroup2,33%ingroup3GVHDFungalARDSOrganfailureCauseofdeaththestudyshowsthattheimprovementisentirelyaresultofalowerTRMduringthelatest5-yearsperiodaGVHDha

8、snochangedduringthisperoidTherewassignificantdifferenceindeathscausedbyIPandbacterialandfungalinfectionConditioningregimeTBI+Melphalanhasnotprevirousbee