Rajkumar S V, Fonseca R, Lacy M Q, Witzig T E, Lust J A, Greipp P R, Therneau T M, Kyle R A, Litzow M R, Gertz M A
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Bone Marrow Transplant. 1999 Jun;23(12):1261-6. doi: 10.1038/sj.bmt.1701787.
We studied the prognostic value of clinical and laboratory variables, measured before blood cell transplantation, in predicting complete response among patients undergoing autologous blood cell transplantation for relapsed or primary refractory myeloma. Sixty-seven patients who underwent transplantation for relapsed or primary refractory myeloma were studied. The overall response rate was 90%, and the complete response rate was 33%. Low beta2-microglobulin (< or =2.7 mg/l) was associated with a significantly better complete response rate compared with high levels (54 vs 19%, P = 0.002). Similarly, the complete response rate was 39% when the bone marrow plasma cell percentage was low (<40%) and 21% with greater involvement (P = 0.04). Complete response rate was 50% when beta2-microglobulin and bone marrow plasma cell percentage were low, 36% if either was high, and 12% when both were high (P = 0.01). Median survival measured from initial diagnosis of myeloma was 51 months. Overall survival after transplantation was better among responders who achieved complete response than those who did not: median survival, 24 vs 11 months, P = 0.04 (log-rank) and 0.009 (Gehan-Wilcoxon). Attainment of a complete response independently predicted better survival in a multivariate analysis. beta2-Microglobulin and bone marrow plasma cell percentage predict complete responders among patients undergoing transplantation for myeloma.
我们研究了血细胞移植前测量的临床和实验室变量对复发或原发性难治性骨髓瘤患者进行自体血细胞移植时预测完全缓解的预后价值。对67例因复发或原发性难治性骨髓瘤接受移植的患者进行了研究。总缓解率为90%，完全缓解率为33%。与高水平相比，低β2-微球蛋白（≤2.7mg/l）与显著更好的完全缓解率相关（54%对19%，P = 0.002）。同样，当骨髓浆细胞百分比低（<40%）时，完全缓解率为39%，当受累程度更高时为21%（P = 0.04）。当β2-微球蛋白和骨髓浆细胞百分比都低时，完全缓解率为50%，若其中一项高则为36%，两项都高时为12%（P = 0.01）。从骨髓瘤初始诊断开始测量的中位生存期为51个月。移植后，达到完全缓解的缓解者的总生存期比未达到完全缓解者更好：中位生存期分别为24个月和11个月，P = 0.04（对数秩检验）和0.009（Gehan-Wilcoxon检验）。在多变量分析中，达到完全缓解独立预测更好的生存期。β2-微球蛋白和骨髓浆细胞百分比可预测骨髓瘤移植患者中的完全缓解者。
