异基因造血干细胞移植治疗多发性骨髓瘤的免疫治疗技术及新药物。

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Allogeneic stem cell transplantation in multiple myeloma: immunotherapy and new drugs.

I***ODUCTION:

Autologous (auto) stem cell transplantation (SCT) and the development of new drugs have improved the survival of multiple myeloma (MM) patients. By contrast, though potentially curative, the use of allogeneic (allo)-SCT is controversial.

AREAS COVERED:

A review has been conducted to examine the current evidence for the use of allo-SCT in MM. We have examined novel cell therapies that may be exploited to induce myeloma-specific immune responses including the new promising frontier of chimeric antigen receptor (CAR)-T and -natural killer (NK) cells.

EXPERT OPINION:

One of the major controversies facing researchers in exploring the allo approach is the remarkable recent treatment improvement observed with second- and third-generation proteasome inhibitors and immunomodulatory drugs, monoclonal antibodies and deacetylase inhibitors. Despite these great advances, the disease remains to be incurable and allo-SCT may still play a role in the cure of MM. We think that allo-SCT conserves a role in MM and its curative potential in high-risk patients should be explored in the setting of control clinical trials. Novel cell therapies such as CAR technologies may open new avenues of research toward a potential cure. Data from currently ongoing prospective studies will be helpful to clarify pending clinical questions.

KEYWORDS:

allogeneic transplantation; bone marrow transplantation; graft-versus-host disease; graft-versus-myeloma; multiple myeloma; new drugs

异基因造血干细胞移植治疗多发性骨髓瘤的免疫治疗技术及新药物。

介绍：

自体造血干细胞移植（SCT）和新药物的发展已经 提高了多发性骨髓瘤患者的存活率。然而，虽然有潜在的治愈优势，但是异基因造血干细胞移植仍然颇受争议。

文章内容：

这篇综述阐明了目前利用异基因造血干细胞移植治疗MM的一些证据。我们研究新的细胞治疗技术能够被开发用于诱导骨髓瘤的特异性免疫应答，如新的具有发展前途的嵌合抗原受体修饰的T细胞技术，和自然杀伤细胞技术。

专家的观点：

研究者们面临的一个主要的争论是近期的研究中，在二代和三代蛋白酶体移植剂和免疫调节药物，单克隆抗体和去乙酰化酶移植剂在使用过程中观察到的显著的改进。尽管有这些巨大的进步，这种疾病仍然是无法治愈的，异基因SCT仍可能在MM的治疗中发挥作用。我们认为异基因造血干细胞移植在MM治疗中具有一定的地位，在控制好的临床情况下，对于高危病人具有其治愈的潜在价值。新型的治疗方案例如CAR-T技术也许会打开新的治疗途径，是第一个潜在的治疗途径。目前正在进行的前瞻性数据对于解决这些问题会有一些帮助。

关键词：

同种异体移植；骨髓移植；移植物抗宿主疾病；移植物抗骨髓瘤；检测多发性骨髓瘤的新的药物；

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