为什么要移植(yízhí)？不同(bùtónɡ)时间段内多发性骨髓瘤主要年龄组患者的10年生存率P<10-5P=0.07BarlogieB,etal.Cancer.2008;113:355–359..以新药为基础的诱导(yòudǎo)方案的疗效ASCT能进一步提高新药诱导(yòudǎo)后的疗效以硼替佐米为基础的诱导(yòudǎo)方案移植的时机目前倾向于作为巩固治疗在疾病早期进行，避免在疾病复发时一般情况(qíngkuàng)差、肾功能不全、年龄增加、过多骨骼破坏以及发生MDS的高风险。病人的年龄(niánlíng)多限定在65岁以下，但也有超出该年龄(niánlíng)病人的报道。肾功能不全不是移植的禁忌症，一般可将马法兰的剂量调整至140mg/m2;如病人有低蛋白血症，可将马法兰的剂量进一步调整至70-100mg/m2。小结(xiǎojié)干细胞动员(dòngyuán)的问题HighrateofstemcellmobilizationfailureafterthalidomideandoralcyclophosphamideinductiontherapyformultiplemyelomaHWAuner,LMazzarella,LCook,RSzydlo,FSaltarelli,JPavlu,MBua,CGiles,JFApperleyandARahemtullaDepartmentofHaematologyHammersmithHospitalImperialCollegeHealthcareNHSTrust,London,UK/Figure1InductiontherapywithCYandthalidomidewithdexamethasone(CTD)impairsthestemcellcollectionyieldandincreasesthenumberofapheresisproceduresrequired.(a)BarsshowthemediannumberofCD34tcells/kgcollectedoverall,onthefirstapheresisday,andperapheresisprocedure.(b)BarsshowthepercentageofpatientsundergoingX2apheresisprocedures./预处理HowtoimprovetheefficacyofconditionregimensBUandCYasconditioningregimenforautologoustransplantinpatientswithmultiplemyelomaGTalamo,DFClaxton,DWDougherty,CWEhmann,JSivik,JJDrabickandWRybkaBoneMarrowTransplantProgram,PennStateMiltonSHersheyCancerInstitute,Hershey,PA,USA/Figure1OSofmultiplemyelomapatientstreatedwiththeBU/CYregimenandASCT(n79),fromday0ofASCT.Thinlinesindicatethe95%confidenceinterval.移植(yízhí)后的巩固与维持治疗2009ASHAbstract351StudyDesignPatientCharacteristicsBestResponsePFSinHigh-riskCytogenetics*BrJHaematol,2008,140:625–634.//Mel干细胞回输G-CSFVVVVConsolidationwithBortezomib+Thalidomide+Dex/清髓性异基因(jīyīn)移植Overallandevent-freesurvivalarenotimprovedbytheuseofmyeloablativetherapyfollowingintensifiedchemotherapyinpreviouslyuntreatedpatientswithmultiplemyeloma:aprospectiverandomizedphase3studyChristineM.Segeren,PieterSonneveld,BronnovanderHolt,etal.ErasmusMedicalCenterRotterdam(ErasmusMC)andUniversityMedicalCenterUtrecht(UMCU)fortheDutch-BelgianHemato-On