异基因造血干细胞移植治疗多发性骨髓瘤课件.ppt
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1、Allogeneic haematopoietic cell transplantation for multiplemyeloma,The allogeneic transplant has the advantage over the autologous transplantThe graft does not contain tumor cells and the potential for a graft versus myeloma(GvM)effect,Bone marrow transplantation in three patients with multiple myel
2、oma 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 donorsOne of the patients,with IgA kappa myeloma,refractory to alkeran-pr
3、ednisone 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 effusive peri
4、carditis 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 were performed
5、during the period 1983-93(all with BM)group 1356 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 to be more commonly used i
6、n 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,Survival,Progression free surviv
7、al,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 GVHDFungal ARDSOrgan failure,Cause of death,the study shows that the improvement is entirely a result of a lower TRM dur
8、ing 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 study,conclusion,Survival 3060%Treatment rel
9、ated mortality30%,Myeloablative allogeneic versus autologous transplantation,during the years 1983 to 1994189 myeloma patients who underwent allo-BMT with an HLA-identical sibling donor were compared retrospectively with an equal number of patients who received a single autologous bone marrow or blo
10、od stem cell graftAnd the ASCT patients were transplanted from 1986 to 1994,conclusionThe 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 the poorer survival in allo-BMT patients was highe
11、r TRM(41%v 13%for ASCT,P=.0001),which was not compensated for by a lower rate of relapse and progression,conclusionHowever,in patients alive at 1 year posttransplant,there was a trend for better long-term survival(P=.O9)and significantly better progression-free survival(P=.02)for allo-BMT as compare
12、d with ASCTWe conclude that the median survival is superior for ASCTHowever,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 final outcome,Reduced-intensity conditioning allogeneic transplantation,The Al
13、lo-RIC was introduced in an attempt to decrease the transplant-related toxicity while retaining the beneficial GvM effect1998 begin clinical study,19982003We report the outcome of 229 patientswho received an allograft for myelomawith reduced-intensity conditioning(RIC)regimens from 33 centers within
14、 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 years were 10%,22%,and 26%,respectively.The cumulative probability of the progression-free
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- 基因 造血 干细胞 移植 治疗 多发性 骨髓瘤 课件
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