摘要
多发性骨髓瘤(MM)是一种常见的血液系统恶性肿瘤,年龄≤65岁初诊MM患者诱导治疗缓解后进行自体造血干细胞移植(ASCT),尽管其生存率得到较大提高,但MM仍然是不可治愈性疾病,ASCT后合理的治疗方式选择可使MM患者获益最大化。本研究总结了MM患者ASCT后的巩固、维持、免疫治疗药物的选择,或者进行异基因造血干细胞移植(allo-HSCT)治疗,分析MM患者ASCT后治疗方案及药物选择、治疗疗效、毒副作用等。应用中国知网和PubMed中英文数据库,以“MM”“造血干细胞移植”“巩固治疗”“维持治疗”“免疫治疗”为关键词,检索2013-05-01-2021-04-31相关文献。纳入标准:(1)多发性骨髓瘤自体造血干细胞移植后的治疗;(2)多发性骨髓瘤自体造血干细胞移植后的巩固治疗;(3)多发性骨髓瘤自体造血干细胞移植后的维持治疗;(4)多发性骨髓瘤自体造血干细胞移植后的免疫治疗。剔除标准:(1)年份较远的综述类文献;(2)文章质量较差、主题模糊的文献。最终纳入分析39篇文献。结果表明,MM患者需根据自身特点选择个体化后续治疗,可以获得长期受益。对于高危MM患者且不进行二次ASCT可以考虑巩固治疗,随后进入维持治疗。ASCT后的MM患者接受或不接受巩固治疗均需进入维持治疗阶段。免疫疗法可以进一步促进MM患者淋巴细胞功能恢复,增强ASCT的疗效。高危患者ASCT后再进行allo-HSCT治疗能够显著获益。提示,MM患者进行ASCT后仍然需要进一步治疗,选择个体化治疗可以有效控制疾病和延缓复发,以期获得长期生存。
Multiple myeloma(MM)is a common hematological malignant tumor.Autologous hematopoietic stem cell transplantation(ASCT)is performed in newly diagnosed MM patients aged≤65 years after remission of induction therapy.Although the survival rate has been greatly improved,MM is still an incurable disease.Reasonable treatment options after ASCT can maximize the benefits of MM patients.This study summarized the choice of consolidation,maintenance,and immunotherapy drugs for MM patients after ASCT,or the treatment of allogeneic hematopoietic stem cell transplantation,and analyzed the treatment methods and drug selection,therapeutic efficacy and side effects of treatment drugs for patients with MM after ASCT.Using China National Knowledge Infrastructure(CNKI)and PubMed databases,with"multiple myeloma","hematopoietic stem cell transplantation","consolidation therapy","maintenance therapy"and"immunotherapy"as keywords,we searched the relevant literatures from May 1,2013 to April 31,2021.Inclusion criteria involves(1)treatment after autologous hematopoietic stem cell transplantation for multiple myeloma;(2)consolidation therapy after autologous hematopoietic stem cell transplantation for multiple myeloma;(3)maintenance therapy after autologous hematopoietic stem cell transplantation for multiple myeloma;and(4)immunotherapy after autologous hematopoietic stemcell transplantation for multiple myeloma.Exclusion criteria contains(1)review literature of a distant age;and(2)literature with poor quality and vague themes.Finally,thirty-nine articles were included.The results showed that MM patients should choose individualized follow-up treatment according to their own characteristics,and can obtain long-term benefits.Consolidation therapy can be considered for high-risk MM patients without secondary ASCT,followed by maintenance therapy.MM patients after ASCT with or without consolidation therapy were required to enter maintenance therapy.Immunotherapy can further promote the recovery of lymphocyte function in MM patients and enhance the efficacy of ASCT.Allogeneic hematopoietic stem cell transplantation(allo-HSCT)after ASCT can significantly benefit high-risk patients.It is suggested that patients with MM still need further treatment after ASCT,and individualized treatment can effectively control the disease and delay recurrence in order to achieve long-term survival.
作者
房昕
刘玉玉
刘芹芹
滕清良
FANG Xin;LIU Yu-yu;LIU Qin-qin;TENG Qing-liang(School of Clinical Medicine,Shandong First Medical University,Jinan 250062,China;Department of Hematology,Tai'an Central Hospital,Tai'an 271000,China)
出处
《社区医学杂志》
CAS
2022年第5期289-294,共6页
Journal Of Community Medicine
基金
山东省医药卫生科技发展计划(202003040818)
泰安市科学技术发展计划(2020NS155,2020NS202)
关键词
多发性骨髓瘤
造血干细胞移植
巩固治疗
维持治疗
免疫治疗
综述文献
multiple myeloma
hematopoietic stem cell transplantation
consolidation therapy
maintenance?treatment
immunological?therapy
review literature
