异体干细胞移植治疗多发性骨髓瘤。

Roberto Bellucci, Jerome Ritz
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引用次数: 40

摘要

骨髓瘤细胞对高剂量化疗的敏感性导致异体造血干细胞移植(HSCT)作为该疾病的治疗方式。除了提供更有效的化疗外,同种异体干细胞的移植也启动了针对残余骨髓瘤细胞的同种异体免疫反应的发展。移植对抗骨髓瘤(GVM)效应的直接证据是,供体淋巴细胞输注(DLI)能够在30-50%的同种异体造血干细胞移植后复发的骨髓瘤患者中诱导显着反应。然而,同种异体干细胞移植也与移植相关毒性的高发相关,包括方案相关毒性、移植物抗宿主病(GVHD)和机会性感染。除了诱导GVM反应外,DLI已被证明可以增强同种异体造血干细胞移植后的免疫重建。目前的研究方向是降低与同种异体造血干细胞移植相关的毒性,鉴定GVM的靶抗原,以及开发新的策略来选择性地增强对骨髓瘤细胞的免疫反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Allogeneic stem cell transplantation for multiple myeloma.

The sensitivity of myeloma cells to high dose chemotherapy has led to the use of allogeneic hematopoietic stem cell transplantation (HSCT) as a therapeutic modality in this disease. In addition to providing more effective chemotherapy, the transplantation of allogeneic stem cells also initiates the development of an allogeneic immune response directed against residual myeloma cells. Direct evidence for a graft vs. myeloma (GVM) effect is provided by the ability of donor lymphocyte infusion (DLI) to induce significant responses in 30-50% of patients with myeloma who have relapsed after allogeneic HSCT. Nevertheless, allogeneic stem cell transplantation is also associated with a high incidence of transplant related toxicities, including regimen-related toxicities, graft vs. host disease (GVHD) and opportunistic infections. DLI has been shown to enhance immune reconstitution after allogeneic HSCT in addition to inducing a GVM response. Current efforts are directed at reducing the toxicities associated with allogeneic HSCT, identification of the target antigens of GVM and the development of new strategies to selectively enhance the immune response to myeloma cells.

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