Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017.
Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017.
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异基因干细胞移植治疗多发性骨髓瘤：2007年至2017年的系统回顾和荟萃分析
DOI：
10.1186/s12935-018-0553-8
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发表时间：
2018
影响因子：
5.8
通讯作者：
Hu Y
中科院分区：
文献类型：
--
作者：
Yin X;Tang L;Fan F;Jiang Q;Sun C;Hu Y
尽管多发性骨髓瘤（MM）的治疗取得了最新进展，但仍无法治愈。然而，异基因干细胞移植（allo-SCT）通过移植物抗骨髓瘤效应的出现，为在一定程度上治愈多发性骨髓瘤提供了潜在的途径。本系统综述旨在评估接受异体干细胞移植患者的预后，并找出一系列可能影响异体干细胞移植预后的因素。
我们以 "异体 "和 "骨髓瘤 "为关键词，系统检索了2007.01.01至2017.05.03期间的PubMed、Embase和Cochrane图书馆。
共纳入61项临床试验，涉及8698名成年患者。1、2、3和5年总生存期（OS）的汇总估计值（95% CI）分别为70（95% CI 56-84%）、62（95% CI 53-71%）、52（95% CI 44-61%）和46（95% CI 40-52%）；无进展生存率分别为51（95% CI 38-64%）、40（95% CI 32-48%）、34（95% CI 27-41%）和27（95% CI 23-31%）；治疗相关死亡率（TRM）分别为18（95% CI 14-21%）、21（95% CI 17-25%）、20（95% CI 13-26%）和27（95% CI 21-33%）。此外，汇总的 100 天 TRM 为 12（95% CI 5-18%）。II-IV级急性移植物抗宿主病（GVHD）和慢性GVHD的发病率分别为34（95% CI 30-37%）和51（95% CI 46-56%）。复发率（RR）和死亡率分别为50（95% CI 45-55%）和51（95% CI 45-57%）。重要的是，疾病进展是最主要的死亡原因（48%），其次是TRM（44%）。与串联自体造血干细胞移植相比，结果未能显示标准风险患者接受异体造血干细胞移植有明显的获益。与此相反，我们研究中的所有14项试验均显示，与标准风险患者相比，接受allo-SCT后的高细胞遗传风险患者的OS和PFS相似，这表明allo-SCT可以克服高细胞遗传风险的不良预后。
由于缺乏持续的生存获益，allo-SCT 不应被视为新诊断和复发标准风险 MM 患者的标准治疗方法。然而，对于长期预后较差的高风险 MM 患者来说，在初始疗程或化疗后首次复发时，当疾病进展的风险可能超过移植相关风险时，异体造血干细胞移植可能是一个强有力的考虑因素。需要大量前瞻性随机对照试验来证明这些治疗方案的益处。
本文在线版（10.1186/s12935-018-0553-8）包含补充材料，授权用户可查阅。
BackgroundDespite recent advances, multiple myeloma (MM) remains incurable. However, the appearance of allogeneic stem cell transplantation (allo-SCT) through graft-versus-myeloma effect provides a potential way to cure MM to some degree. This systematic review aimed to evaluate the outcome of patients receiving allo-SCT and identified a series of prognostic factors that may affect the outcome of allo-SCT.Patients/methodsWe systematically searched PubMed, Embase, and the Cochrane Library from 2007.01.01 to 2017.05.03 using the keywords ‘allogeneic’ and ‘myeloma’.ResultsA total of 61 clinical trials involving 8698 adult patients were included. The pooled estimates (95% CI) for overall survival (OS) at 1, 2, 3 and 5 years were 70 (95% CI 56–84%), 62 (95% CI 53–71%), 52 (95% CI 44–61%), and 46 (95% CI 40–52%), respectively; for progression-free survival were 51 (95% CI 38–64%), 40 (95% CI 32–48%), 34 (95% CI 27–41%), and 27 (95% CI 23–31%), respectively; and for treatment-related mortality (TRM) were 18 (95% CI 14–21%), 21 (95% CI 17–25%), 20 (95% CI 13–26%), and 27 (95% CI 21–33%), respectively. Additionally, the pooled 100-day TRM was 12 (95% CI 5–18%). The incidences of grades II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 34 (95% CI 30–37%) and 51 (95% CI 46–56%), respectively. The incidences of relapse rate (RR) and death rate were 50 (95% CI 45–55%) and 51 (95% CI 45–57%), respectively. Importantly, disease progression was the most major cause of death (48%), followed by TRM (44%). The results failed to show an apparent benefit of allo-SCT for standard risk patients, compared with tandem auto-SCT. In contrast, all 14 trials in our study showed that patients with high cytogenetic risk after allo-SCT had similar OS and PFS compared to those with standard risk, suggesting that allo-SCT may overcome the adverse prognosis of high cytogenetic risk.ConclusionDue to the lack of consistent survival benefit, allo-SCT should not be considered as a standard of care for newly diagnosed and relapsed standard-risk MM patients. However, for patients with high-risk MM who have a poor long-term prognosis, allo-SCT may be a strong consideration in their initial course of therapy or in first relapse after chemotherapy, when the risk of disease progression may outweigh the transplant-related risks. A large number of prospective randomized controlled trials were needed to prove the benefits of these therapeutic options.
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影响因子：
45.3
作者：
Andrykowski, MAA;Bishop, MM;Wingard, JR
通讯作者：
Wingard, JR
影响因子：
20.3
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影响因子：
45.3
作者：
Barlogie, B;Kyle, RA;Crowley, JC
通讯作者：
Crowley, JC
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45.3
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Bjorkstrand, Bo;Iacobelli, Simona;Gahrton, Gosta
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