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ID:62077397
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时间:2021-04-14
《最新[临床医学]异基因造血干细胞移植治疗多发性骨髓瘤教学讲义PPT.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、[临床医学]异基因造血干细胞移植治疗多发性骨髓瘤TheallogeneictransplanthastheadvantageovertheautologoustransplantThegraftdoesnotcontaintumorcellsandthepotentialforagraftversusmyeloma(GvM)effectBonemarrowtransplantationinthreepatientswithmultiplemyelomaGahrtonG,RingdénO,LönnqvistB,L
2、indquistR,LjungmanP.ActaMedScand1986;219(5):523-7.瑞典卡罗林斯卡医学院1983MyeloablativeconditioningOutof690allogeneticmatchedsiblingdonortransplantsforMM344wereperformedduringtheperiod1983-93(allwithBM)[group1]356during1994-98(223withBMgroup2and133withPBgroup3)themedi
3、anageattransplantationofpatientsingroup1was43years(range21-62)Ingroup2,44years(range18_57)andingroup3,46years(range25_60)TBI+CYtendedtobemorecommonlyusedingroup1(37%)and2(39%)thaningroup3(27%)Melphalancontainingregimestendedtobemorelyusedingroup3MelphalanorB
4、usulphan+CYrarelyConditiongregimeEngraftmentGVHDTreatment–relatedmortalityTreatment–relatedmortalityRelapserateRelapserateSurvivalSurvivalProgression–freesurvivalPFSwassignificantlybetterforgroup2thanforgroup1(P<0.0001)Withnosignificantlydifferencebetweengro
5、up2and3Causeofdeath75%ingroup1,36%ingroup2,33%ingroup3GVHDFungalARDSOrganfailureCauseofdeaththestudyshowsthattheimprovementisentirelyaresultofalowerTRMduringthelatest5-yearsperiodaGVHDhasnochangedduringthisperoidTherewassignificantdifferenceindeathscausedbyI
6、PandbacterialandfungalinfectionConditioningregimeTBI+MelphalanhasnotprevirousbeenShowntobesuperiortoTBI+CYinthisstudyconclusionSurvival30~60%Treatment–relatedmortality30%Myeloablativeallogeneicversusautologoustransplantationduringtheyears1983to1994189myeloma
7、patientswhounderwentallo-BMTwithanHLA-identicalsiblingdonorwerecomparedretrospectivelywithanequalnumberofpatientswhoreceivedasingleautologousbonemarroworbloodstemcellgraftAndtheASCTpatientsweretransplantedfrom1986to1994conclusionTheoverallsurvivalwassignific
8、antlybetterforASCTthanforallo-BMT,withamediansurvivalof34monthsand18months,respectively(P=.001),Themainreasonforthepoorersurvivalinallo-BMTpatientswashigherTRM(41%v13%forASCT,P=.0001),whichwasno
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