Gertz M A, Lacy M Q, Inwards D J, Chen M G, Pineda A A, Gastineau D A, Greipp P R, Lust J A, Tefferi A, Witzig T E, Kyle R A, Litzow M R
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Bone Marrow Transplant. 1999 Feb;23(3):221-6. doi: 10.1038/sj.bmt.1701559.
Transplantation after high-dose chemotherapy prolongs survival in patients with multiple myeloma compared with standard therapy. It is unclear whether the optimal timing of transplantation is immediately after induction chemotherapy or whether stem cells may be cryopreserved for transplantation at subsequent progression or relapse. In this study, stem cells were collected within 6 months of diagnosis, followed by transplantation only at progression of myeloma. One hundred and eighteen patients with multiple myeloma had stem cells collected and cryopreserved. Eleven had transplants early in the disease after they demonstrated failure to respond to primary therapy. The remaining 107 were eligible for transplants when there was evidence of progressive disease. Of the 118 patients, 67 had transplants, nine died of progressive disease before transplantation, and 42 remain alive in plateau phase. The median survival of the group is 58.5 months; 67 are alive. Serum beta2-microglobulin, bone marrow labeling index (S phase), and hemoglobin level predicted overall survival (P < 0.006, P < 0.001, and P < 0.01, respectively). We conclude that early cryopreservation of blood stem cells followed by transplantation at progression is a feasible approach to therapy in patients with myeloma. The underlying biology of the disease has a greater impact on survival than the timing of transplantation. A prospective randomized trial is required to answer definitively the question of the optimal timing of blood cell transplantation.
与标准疗法相比，大剂量化疗后进行移植可延长多发性骨髓瘤患者的生存期。目前尚不清楚移植的最佳时机是在诱导化疗后立即进行，还是干细胞可以冷冻保存以便在后续病情进展或复发时进行移植。在本研究中，干细胞在诊断后6个月内采集，随后仅在骨髓瘤进展时进行移植。118例多发性骨髓瘤患者采集并冷冻保存了干细胞。11例患者在对初始治疗无反应后在疾病早期进行了移植。其余107例在有疾病进展证据时符合移植条件。118例患者中，67例进行了移植，9例在移植前死于疾病进展，42例仍处于平台期存活。该组患者的中位生存期为58.5个月；67例存活。血清β2微球蛋白、骨髓标记指数（S期）和血红蛋白水平可预测总生存期（分别为P<0.006、P<0.001和P<0.01）。我们得出结论，早期冷冻保存造血干细胞随后在疾病进展时进行移植是骨髓瘤患者可行的治疗方法。疾病的基础生物学特性对生存期的影响大于移植时机。需要进行一项前瞻性随机试验来明确回答血细胞移植最佳时机的问题。
