Bone marrow transplantation, although the modern chemotherapy can significantly prolong survival in patients with osteosarcoma, but not cure the disease. In recent years, disease-based bone marrow transplantation has become an important treatment.
(1) multi-use high-dose conditioning regimen MELCloO–14Omg/m2 and systemic radiotherapy (TBI, 8.0 ~ 12.0Gy), the TBC can be applied without TBI program (TSPA, 750mg/rn spoon BllS, 10mg/kg ; CTX, 12 Gaya ng / kg).
(2) allogeneic bone marrow transplantation in Europe and America and other countries reported that a group of 101 cases of allogeneic bone marrow transplantation (allo-BMT), 50% ~ 75% as high risk, refractory patients, median time from diagnosis to transplant 19 to 20 months The results 61% achieved complete remission, the median response of 48 to 60 months, 3 year disease-free survival rate of 40%, transplant-related mortality rate of 16%. 1995 Barlogie comprehensive analysis of 268 cases of allo-BMT treatment of MM data, CR rate of 35%, 5-year disease-free survival rate was 35%, transplant-related mortality rate as high as 40%. Generally believed that early chemotherapy-sensitive MM, shorter time from diagnosis to transplantation is effective allo BMT A main constraint is the age and for the marrow were (only a small fraction of patients with conditions for allo-BMT).
(3) autologous stem cell transplantation in a large sample of clinical studies have demonstrated that autologous stem cell transplantation (A district of f) can improve the CR rate of MM and prolong survival time. ASCT, including autologous bone marrow transplantation (ABMT) and autologous peripheral blood stem cell transplantation browsing. Generally choose a large number of anti-tumor cells after chemotherapy, bone marrow hematopoietic function of bone marrow collected in the recovery period, the use of lID-CTX (6.Og/m2) + G-CSF for mobilization of the blood cell separator in peripheral blood stem cell collection.
Application of European and American centers 8 AS (established first-line treatment of 571 cases, the diagnosis of osteosarcoma to transplant time mostly in the 12 months, with a median age of 50 years median follow-up of 24 months, CR rate of 42% (22% – 77 %), median disease-free survival of 30 months, transplant-related mortality rate 5%, PBSCT and ABMT long-term efficacy is similar. transplant before the 132-MG level of sensitivity to chemotherapy, transplant survival after the effect is the main factor of long- .
ASCT main issues are:
the current conditioning regimen is difficult to completely remove the tumor cells in vivo.
Bone marrow transplantation, P transfusion of bone marrow or political exchange with tumor cells. Both the high relapse rate after ASCT is the reason. CD really PBSC positive selection in vitro to reduce tumor cells 2.7 – 4.5 logarithmic level, in vitro purification of monoclonal antibodies is not yet sure.