多发性骨髓瘤自体干细胞移植预处理方案进展

Progress in Conditioning Regimen for Autologous Stem Cell Transplantation in Multiple Myeloma

摘要: 多发性骨髓瘤是血液系统第二大恶性肿瘤，新药来临之后多发性骨髓瘤患者治疗效果较好，但终面临复发风险。对于符合移植条件的患者来说自体干细胞移植仍是主要治疗方案。预处理是自体干细胞移植的重要过程，大剂量马法兰是现在主流的预处理方案。本文从马法兰用量、种类、马法兰联合其他药物几方面来概述了多发性骨髓瘤自体干细胞移植预处理方案进展。结论：预处理方案需做到有效性和安全性二者兼顾。以马法兰为基础的联合用药方案虽显示出患者可能获益，但实验样本量较少，需要进一步验证。目前MM患者预处理方案仍是推荐马法兰(200 mg/m²)，对于年龄大于65~70岁以上或肾功能不全(肾小球滤过率低于60 ml/min)患者可减为140 mg/m²。

Abstract: Multiple myeloma is the second most common malignant tumor of the hematologic system, and pa-tients with multiple myeloma respond well to treatment after the advent of new drugs, but eventu-ally face the risk of relapse. Autologous stem cell transplantation remains the mainstay of treat-ment for patients eligible for transplantation. Transplantation conditioning is an important process in autologous stem cell transplantation, and high-dose melphalan is now the mainstream trans-plantation conditioning regimen. In this paper, the progress of transplantation conditioning regi-men of autologous stem cell transplantation for multiple myeloma is summarized from the aspects of melphalan dosage, type, melphalan combined with other drugs. Conclusion: Transplantation con-ditioning regimen should be combined with efficacy and safety. Although melphalan based combi-nation regimens have shown possible benefits, the experimental sample size is small and requires further validation. At present, the conditioning regimen for MM patients is still recommended mel-phalan (200 mg/m²), which can be reduced to 140 mg/m² for patients older than 65~70 years or with renal insufficiency (glomerular filtration rate less than 60 ml/min).