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1、,自体造血干细胞移植治疗恶性淋巴瘤应用进展,Indications for Hematopoietic Stem Cell Transplants in the United States,2010(Inflation factor:Auto=1.25(80%),Allo=1.05(95%),All Transplants),SUM12_28.ppt,Slide 8,Number of Transplants,1.HL,霍奇金淋巴瘤,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,HL:ASCT 综合治疗效果,复发/耐药：CR 34-80%长期生存率：
2、25-50%早期死亡率：421复发/耐药：10年生存率：50%10y PFS：45%10y RFS：23%首次复发：5年PFS 30 52%,5年生存率：3460,复发难治HL PET/CT结果与自体移植的疗效关系,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,Haematologica 2012,PET/CT-,PET/CT+,复发难治HD:不同预处理方案比较,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,1998-2009100 ptsBuMelTt(busulfan,melphalan,thiotep
3、a):60ptsOthers:40ptsCBV(21)TBICyE(14)BEAM(4)Melphalan(1)5 yr-OS 73%VS.44%5 yr-PFS 66%VS.37%No differences in toxicity and NRM,Improved outcome with busulfan,melphalan and thiotepa conditioning in AHSCT for relapsed/refractory HL,Tarunpreet B.Leukemia 55(3):583587,PFS,OS,P=0.03,P=0.05,2.NHL,DLBCL弥漫大B
4、淋巴瘤,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,复发NHL:自体移植是标准治疗手段 PARMA 随机对照研究,OS,PFS,美罗华治疗后复发：AHSCT价值，2nd,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,Rituximab+DHAP and ASCT 复发DLBCL,Edo Vellenga et al,blood,2008 111:537-543,DHAP112 73 40 19 9R-DHAP113 76 55 31 14,R-DHAP,DHAP,Cumulative percentage
5、,Overall survival,CORAL研究：移植后疗效 EFS,Failure from diagnosis=12 months,Failure from diagnosis 12 months,Failure from diagnosis=12 months,Standard salvage regimen does not overcome poor prognosis of early relapse,Rituximab-化疗复发：自体移植的疗效,Br J Haematol.2014 Mar;164(5):668-74.有研究提示，美罗华化疗后复发患者自体移植效果差？移植后 5年
6、 R+vs R-PFS 63%48%OS 72%61%美罗华治疗后不会影响移植效果,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,弥漫大B淋巴瘤：一线,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,美罗华之前：ASHCT DLBCL 1st,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,Advances in Hematology,2012 意大利,DLBCL一线治疗:HDCT试验的荟萃分析,Greb et al.,2007,Cancer Treat Rev,美罗
7、华时代：自体移植疗效，1st,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,Advances in Hematology,2012 意大利,自体移植+/-rituximab 治疗初治高危弥漫大BNHL，III期随机对照,OS,EFS,Annals of Oncology Advance Access published May 5,2010,Dose-dense and high-dose chemotherapy plus rituximab+ASHSCT for primary treatment of DLBCLwith a poor prog
8、nosis:a phase II multicenter study,R-HDC,HDC,R-HDC,HDC,haematologica|2009;94(9),R-HDC,HDC,HDC,R-HDC,SWOG-9704 研究设计,Stiff P,et al.N Engl J Med 2013;369(18):1681-1690.,SWOG-9704 显示：移植组较对照组显著延长2年PFS，但是OS上无差别,Stiff P,et al.N Engl J Med 2013;369(18):1681-1690.,SWOG-9704亚组分析显示：移植组在aaIPI为3分的患者中可以较对照组明显延长患者
9、PFS,Stiff P,et al.N Engl J Med 2013;369(18):1681-1690.,SWOG-9704亚组分析显示：移植组在aaIPI为3分的患者中可以较对照组明显延长患者OS,Stiff P,et al.N Engl J Med 2013;369(18):1681-1690.,原发中枢淋巴瘤：自体移植价值HD AraC+VP16(CYVE)+HDCT(TT-BU-CY)as salvage for relapse/resistant PCNSL,2011 updateN=60,median FU 5yOS chemosensitive 97 m chemoresis
10、tant 18 m ICML 2011 Abstr.035,Resp+HDCT,No Resp+HDCT,Resp no HDCT,NO resp no HDCT,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,继发中枢淋巴瘤移植效果好！,化疗敏感 62%vs 不敏感36.2%,Thiotepa,busulfan and cyclophosphamide+AHSCT，复发难治原发中枢淋巴瘤,5yOS,CR 56.4%vs 未CR 31.1%,Haematologica.2012 Nov;97(11):1751-6.,AHSCT前CR/PR，移植后CR患
11、者（5y-OS 62%）AHSCT前SD/PD，移植后CR患者（5y-OS 38.9%）移植后未获得CR患者（5y-OS 31.1%）,Thiotepa,busulfan and CTX+AHSCT for relapsed or refractory PCNSL/PLOT,Haematologica.2012 Nov;97(11):1751-6.,2000 至2010 年27例中位年龄:59岁中位 ECOG评分:276%DLBCL中位OS 7月1年OS：62%,自体移植治疗淋巴瘤继发中枢侵犯 an International Primary CNSL Study Group project,
12、ASCT：DLBCL临床资料,70例，中山大学肿瘤医院男性41例，女性29例中位年龄43岁（21-76岁）中位随访时间35.5月（月）因肿瘤死亡29例,DLBCL OS 生存曲线 中山大学肿瘤医院,1年OS 91.0%,3年OS 77.7%,5年OS 56.9%,AHSCT：复发难治老年DLBCL-日本血液学协会回顾性研究，2013ASH,1993-2010年484pts中位64岁（60-78）中位随访26.5月移植相关死亡-4.1%(100天)-5.9%（1年）-10.7%3年）2年 PFS 48%，OS 58%60-64,65-69，70岁，移植相关死亡无差异OS预后因素：70岁，PS 2
13、-4分，移植前未CRBiol Blood Marrow Transplant.2014 Jan 31.,100d:4.1%1 yr:5.9%2 yr:7.7%3 yr:10.7%,复发难治老年弥漫大B淋巴瘤DLBCL:A Nationwide Retrospective Study,Dai Chihara.Biol BMT.20(2014)684-689,1993 to 2010 yearJapan Society for HCT database484 patients median age:60 years,The cumulative risk of relapse 1-yr:38.8%
14、2-yr:45.5%3-yr:47.7%Multivariate analysis 70y PS 2 to 4 at ASCT not in remission at ASCT,High-Dose Chemotherapy with ASCT for Elderly Patients with Relapsed/Refractory DLBCL:A Nationwide Retrospective Study,Dai Chihara.Biol BMT.20(2014)684-689,1-yr:55.9%2-yr:47.7%3-yr:40.6%,1-yr:69.7%2-yr:57.9%3-yr:
15、49.6%,Dai Chihara.Biol BMT.20(2014)684-689,High-Dose Chemotherapy with ASCT for Elderly Patients with Relapsed/Refractory DLBCL:A Nationwide Retrospective Study,High-Dose Chemotherapy with ASCT for Elderly Patients with Relapsed/Refractory DLBCL:A Nationwide Retrospective Study,2-yr OS 6064 64.6%656
16、9 50.6%70y 45.7%,Dai Chihara.Biol BMT.20(2014)684-689,Zevaline+BEAM:DLBCL 1st line,2011 lugano abs 256,GELA,法国 75 DLBDL,R-CHOP/R-ABVCP IPI 1 1;IPI 2 27;IPI 3-5 47 F/U 23m,2y EFS 74%,2y OS 80.5%PET+/-before AHSCT:same 1 toxic death promising with acceptable toxicity.,Zevalin+BEAM vs BEAM AHSCT for Ag
17、gressive Lymphoma,43 CD20+pts 中位年龄55岁 病理类型-DLBCL-transformed FL,Zevalin+BEAM N=22,BEAM N=21,R,AHSCT,Z-BEAM-Rituximab 250 mg/m2-Zevalin 0.4 mCi/kg d-14-Carmustine 300 mg/m2 d-6-Etoposide 200 mg/m2 d-5-2-Cytarabine 200 mg/m2 Q12h d-5-2-Melphalan 140 mg/m2 d-1,Cancer.2012 Oct 1;118(19):4706-14,2y-OS:91
18、%VS 62%(P=0.05),Zevalin+BEAM vs BEAM AHSCT for Aggressive Lymphoma,2y-PFS:59%VS 37%(P=0.2),Cancer.2012 Oct 1;118(19):4706-14,23 ptswithout CR to salvage chemotherapy6 pts RIT combined with HD-chemotherapy8 pts received a sequential HD-chemotherapy with a second ASCT,Myeloablative Anti-CD20 RIT High-
19、Dose Chemotherapy Followed by ASCT for Relapsed/Refractory B-Cell Lymphoma Results in Excellent Long-Term Survival,Wagner JY.Oncotarget,June,Vol.4,No 6,The ORR 87%CR:64%Median PFS 47.5mMedian OS 101.5 months,Myeloablative Anti-CD20 RIT High-Dose Chemotherapy Followed by ASCT for Relapsed/Refractory
20、B-Cell Lymphoma Results in Excellent Long-Term Survival,Wagner JY.Oncotarget,June,Vol.4,No 6,(A)OS according to treatment modality(B)PFS according to treatment modality,(C)OS RIT VS.RIT/HD-CTX or RIT/BEAM(D)PFS RIT VS.RIT/HD-CTX or RIT/BEAM,Myeloablative Anti-CD20 RIT High-Dose Chemotherapy Followed
21、 by ASCT for Relapsed/Refractory B-Cell Lymphoma Results in Excellent Long-Term Survival,Wagner JY.Oncotarget,June,Vol.4,No 6,Philippe A.J Clin Oncol 31:4199-4206.,PD-1 Blockade Pidilizumab+AHSCT DLBCL an International Phase II Trial,66例30 centers in USA化疗敏感复发，Chemotherapy sensitive,66pts,Pidilizuma
22、b(PD-1)1.5 mg/kg3,Q42d 30 to 90d from AHSCT,AHSCT,Restagedat 30,44,and 69 w,OS(16m):85%PFS(16m):72%,Disabling Immune Tolerance by PD-1 Blockade With Pidilizumab After AHSCT for DLBCL:Results of an International Phase II Trial,PFS and OS of all eligible patients,PFS and OS of the 24 eligible patients
23、 who PET(+)after salvage therapy,PFS(16m):70%(PET+)72%(PET-),Philippe A.J Clin Oncol 31:4199-4206.,3.PTCL-U 外周非特异性,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,复发耐药T-NHL长期随访结果，常规化疗,N=45,总生存曲线,黄慧强等，2007 癌症,ASCT 治疗外周T淋巴瘤：一线,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,ASCT 外周T淋巴瘤：复发,中山大学肿瘤医院SUN YAT-SE
24、N UNIVERSITY CANCER CENTER,T-NHL自体干细胞移植随访结果,35 例,中位随访23个月，预计中位总生存54个月，PTCL-U 17.1%，LBL 42.9%，ALCL20%，NK/T 14.33%，皮下脂膜炎样T 5.7%1，3，5年OS为71%，59%，46%,中山大学肿瘤医院内科,ASHCT 治疗T-NHL(一线/复发),2011 lugano ICML,abs 100 MDACC 美国126例，49（18-75），初治33，预处理：BEAM 4年 OS PFS CR1 87 67 敏感复发 39 36 难治 24 15 PTCLU 42 48 ALCL 47
25、37 NK/T 6 67 LBL 14 AHSCT 考虑一线应用,AutoHSCT vs alloHSCT T-NHL:CIBMTR analysis(19962006),自体，autoHCT(n=115)more in ALCL(53%vs.40%,p=0.04)less advanced:CR1(35%vs.14%,p=0.001),chemosensitive disease(86%vs.60%,p0.0001)2 lines prior therapy(65%vs.44%,p0.001)异基因，alloHCT(n=126,76 matched siblings),100 d TRM 1
26、yr OS 3yr OS 复发死亡 autoHCT 2%62%53%73%alloHCT 17%52%41%44%,Sonali Smith,et al.ASH2010,Abstract 689.,Hematopoietic Cell Transplantation for Systemic MatureT-Cell Non-Hodgkin Lymphoma,NRM:non relapse mortality,Sonali M.J Clin Oncol 31:3100-3109.,241pts-ALCL(112)-PTCL-U(102)-AITL(27)60 yr Lines prior to
27、 transplantation-3(164)-3(73),autoHCT N=115,Primary outcomesPFSNRMOS,alloHCT N=126,OS,PFS,NRM,NRM,PFS,OS,Sonali M.J Clin Oncol 31:3100-3109.,Hematopoietic Cell Transplantation for Systemic MatureT-Cell Non-Hodgkin Lymphoma,PFS,OS,NRM,PFS,OS,Hematopoietic Cell Transplantation for Systemic MatureT-Cel
28、l Non-Hodgkin Lymphoma,Sonali M.J Clin Oncol 31:3100-3109.,P Corradini.Leukemia(2014),17,Intensified chemo-immunotherapy SCT in newly diagnosed PTCL,AL:alemtuzumab HyperCHidam:-HD-MTX 1.6 g/m2 d1,-CTX 300 mg/m2 Q12h d1-3-HD-Ara-C 2 g/m2 Q12h d1-3,P Corradini.Leukemia(2014),17,Clin A study-4 yr OS 49
29、%-4 yr PFS 44%-4 yr DFS 65%,Intensified chemo-immunotherapy SCT in newly diagnosed PTCL,P Corradini.Leukemia(2014),17,Clin B study-4 yr OS 32%-4 yr PFS 26%-4 yr DFS 44%,Intensified chemo-immunotherapy SCT in newly diagnosed PTCL,晚期、复发NK/T 淋巴瘤,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,，自体外周血造血干细胞移
30、植:NKT淋巴瘤，1st,获益患者CR、III-IV期预后不良,（kim HJ,et al.Bone Marrow Transplant.2006),自体移植:III/IV 期和复发难治 NK/T Promising,3-y OS 78.6%13.9%3-y PFS 63.6%14.5%,Huang hui-qiang,et al in press,中山大学肿瘤医院 SYSUCC,P-Gemox CR/PR自体移植,YDM,女，24岁，IVB NK/T,腹部巨大肿块，PS=2 腹腔肠道广泛受累 1疗程后肠穿孔，人工肛，PEG-Gemox 6疗程，CR ASCT 后12个月 CCR,Upfron
31、t Autologuos Stem-Cell Transplantation in Peripheral T-Cell Lymphoma:NLG-T-01,5y-OS 51%,5y-PFS 41%,J Clin Oncol.2013 May 1;31(13):1624-30.,4.FL，滤泡型淋巴瘤,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,Randomized Trials of Upfront Autologous Transplantation for FL,1.Gyan E,et al.Blood.2009;113:995-1001.2.
32、Lenz G,et al.Blood.2004;104:2667-2674.3.Sebban C,et al.Blood.2006;108:2540-2544.4.Ladetto M,et al.Blood.2008;111:4004-4013.,Long term outcome of AHSCT 复发滤泡型,248 pts,age 47(20-67)yMedian prior chemotherapies 2,110 pts AHSCT onlyMedian F/U 6 years(1-16)y47%progression13%died without NHL44%5Y EFS 63%5y
33、 OS2005 ASCO,abstract 6567J Vose et al University of Nebraska medical center,CUP trial:PFS,1.00.80.60.40.20,012 24 36 48 60 72 84,Months,Proportion progression-free,EventsTotalChemotherapy2024Unpurged 922Purged1124,Schouten H,et al.J Clin Oncol 2003;21:391827,Tandem Transplant for，双移植 Follicular NHL
34、60y,36pts advanced/recurrent FL;previously untreated 26.Treatment:C2H2OP2 Melphalan140mg/m2 CTX120mg/kg+TBI CR(%)30.6 62.9 94.3Median F/U 86m.10y DFS 60%10y OS 83%Conclusion-tandem transplant is safe and could be curative for selected FL-No correlation between molecular and clinical relapse.Christia
35、m Recher.France 2003 ASH,研究流程,复发FL:移植前利妥昔单抗净化和/或移植后维持EBMT一项前瞻性研究,ASCT,Ruth P.J Clin Oncol 31:1624-1630,10 yr PFS:48.6%vs.42%(P=0.18),Effect on PFS,10 yr PFS:54%vs.37%(P=0.12),是否Rituximab净化,是否Rituximab维持,Ruth P.J Clin Oncol 31:1624-1630,复发FL:移植前利妥昔单抗净化和/或移植后维持EBMT一项前瞻性研究,ASCT,Sequential therapy with
36、alternating short courses of R-chop and R-FM followed by ASCT results inlong term remission in advanced FL,10 yr OS 87%10 yr PFS 65%10 yr OS(treated at disease relapse)70%10 yr PFS(treated at disease relapse)60%,Author N F/U PFS(%)OS(%)Foran 29 29 52(48)50(102)Friedberg 27 36 46(60)58(60)Williams 50
37、 59 30(60)37(60)Chen 35 52 31(60)37(60),移植后远期生存率：PFS:30-52%,OS 37-58%,ASCT:转化滤泡型淋巴瘤,转化的惰性淋巴瘤:自体造血干细胞移植随机对照,105pts 中位年龄：54岁 病理类型：DLBCL(102)1996-2009年,50(48%)例接受AHSCT,55(52%)例未接受AHSCT,R,AHSCT VP-16 Mephalan TBI,IFRT 30-35Gy(Bulk disease),D.Villa.Annals of Oncology24:16031609,2013,Overall Survival,Prgr
38、ession-Free Survival,ASCT vs.No ASCT,ASCT(2005年后)vs.ASCT(2005年前),D.Villa.Annals of Oncology24:16031609,2013,转化的惰性淋巴瘤:自体造血干细胞移植随机对照,移植前加用rituximab VS.移植前未使用rituximab,Overall Survival,D.Villa.Annals of Oncology24:16031609,2013,转化的惰性淋巴瘤:自体造血干细胞移植随机对照,High-dose RIT+AHCT for poor-risk or relapsed B-cell
39、NHL,No transplant-related death30(97%)pts engraftedMedian follow-up of 21 months(range 1.4-43):2-year estimated OS 93%2-year estimated DFS 80%ConclusionsThe novel High-dose RIT with ZEVALIN+high-dose VP-16 and CY is well tolerated and effective in refractory B-cell NHL,Autologous and Allogeneic SCT
40、for Transformed FL:A Report of the Canadian BMT,J Clin Oncol.2013 Mar 20;31(9):1164-71.,双移植 auto-allo transplant 复发难治滤泡,Biol Blood Marrow Transplant.2012 Jun;18(6):951-7.27 例，3 线随访39 月,OS 96%3年PFS 96%,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,5.套细胞淋巴瘤MCL,1.套细胞淋巴瘤2008，2009R-CHOP+AHSCT:R-CHOP+IFN,P
41、FS R-CHOP+AHSCT VS IFN,PFS，R-CHOP+AHSCT VS 其他,年轻一线：MCL1 vs MCL 2,套细胞淋巴瘤长期随访：MCL2方案,360 例患者2000-2009年18岁 Multivariate analysis,一项EBMT关于套细胞淋巴瘤移植后复发的预后因素和生存研究的回顾性分析,S.Dietrich.Annals of Oncology25:10531058,2014,Median OS:19m,Relapesd 12m,S.Dietrich.Annals of Oncology25:10531058,2014,一项EBMT关于套细胞淋巴瘤移植后复发
42、的预后因素和生存研究的回顾性分析,First line vs.salvage SCT,OS after ASCT failure by timing of first ASCT,OS after ASCT failure by refractory disease,Sensitive vs.refractory,S.Dietrich.Annals of Oncology25:10531058,2014,一项EBMT关于套细胞淋巴瘤移植后复发的预后因素和生存研究的回顾性分析,2000-2003年 vs.2004-2007年,OS after ASCT failure by calendar ye
43、arof relapse,OS from 3 months landmark after ASCT failure by response to first-salvage regimen given for relapse,CR vs.PR vs.SD/PD,S.Dietrich.Annals of Oncology25:10531058,2014,一项EBMT关于套细胞淋巴瘤移植后复发的预后因素和生存研究的回顾性分析,Nordic MCL3 研究:90Y-ibritumomab-tiuxetanadded 联合BEAM/C 治疗移植前未CR的套细胞淋巴瘤,Arne K.Blood.2014
44、 123:2953-2959,160pts Untreated Stage II-IV 66 yr,MCL2 6 R-maxi-CHOP R-HD-Ara-C,RESP O NDING,CR,CRu/PR Zevalin1 1w before ASCT Rituximab 250mg/m2 1 w before and just prior to Zevalin,AHSCT BEAM/BEAC,EFS OS PFS,Survival curves for MCL2 and MCL3,Nordic MCL3 研究:90Y-ibritumomab-tiuxetanadded 联合BEAM/C 治疗
45、移植前未CR的套细胞淋巴瘤,Arne K.Blood.2014 123:2953-2959,移植前基于PET/CT扫描结果的生存曲线,PFS,OS,Nordic MCL3 研究:90Y-ibritumomab-tiuxetanadded 联合BEAM/C 治疗移植前未CR的套细胞淋巴瘤,Arne K.Blood.2014 123:2953-2959,基于微小病灶残留检测的PFS曲线,移植前,移植后,Nordic MCL3 研究:90Y-ibritumomab-tiuxetanadded 联合BEAM/C 治疗移植前未CR的套细胞淋巴瘤,Arne K.Blood.2014 123:2953-29
46、59,移植前获得CR和Cru/PR患者的DOR曲线,Arne K.Blood.2014 123:2953-2959,Nordic MCL3 研究:90Y-ibritumomab-tiuxetanadded 联合BEAM/C 治疗移植前未CR的套细胞淋巴瘤,6.Allo-HSCT 和其他,Improved supportive therapy and outcome after auto vs.alloHSCT?,Allogeneic SCT over time,Autologous SCT over time,But:-retrospective study with heterogenous
47、 patient population-TBI conditioning regimen significantly lower relapse rate(p=0.02)-no specific prognostic factors after autologous/allogeneic transplantation,van Besnien et al.Blood 2003,Zevaline+allo-BMT:R/R NHL,202例19982010年清髓(MA)74例，非清髓(RIC/NST)128例,allo-HCT for chemotherapy-unresponsive MCL:A
48、 cohort analysis from the CIBMTR,202pts Unresponsive,清 髓 N=74,主要研究终点PFSNRMOS,非清髓 N=126,Mehdi H.Biol BMT.2013 April;19(4):625631,PFS,OS,清髓 vs.非清髓,P=0.53,P=0.45,Mehdi H.Biol BMT.2013 April;19(4):625631,allo-HCT for chemotherapy-unresponsive MCL:A cohort analysis from the CIBMTR,移植后长期存活患者聚会,中山大学肿瘤医院,中山
49、大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,纵隔大B-NHL：移植后无病生存15年,NHL,IV期，自体干细胞移植后7年,PBSC的动员？,大剂量G-CSF 联合生长因子：G-CSF+GM-CSF 长效G-CSF 新动员剂：mozobil,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,自体移植，ASCT 适应症：淋巴瘤,1.敏感复发 DLBCL 2.初治高危（aa IPI 3）弥漫 大B细胞，3.首次常规化疗仅获PR1，DLBCL,4.敏感复发低度恶性，FL,复发MALT 5.套细胞淋巴瘤一线，二线？5.复发霍奇金淋巴瘤 6.外周T细胞，初治NK/T 晚期、复发难治 7.其 他：初治LBL？,展望：如何提高ASCT疗效,移植前尽量降低肿瘤负荷，PET/CT Tandem 移植，双移植（auto-auto;auto-allo）新药治疗，thalidomide？PD-1单抗 长效干扰素 其他,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,移植病房启用20年纪念,中山大学肿瘤医院SUN YAT-SEN UNIVERSITY CANCER CENTER,THANK YOU！,中山大学肿瘤防治中心,
