Alyea E, Weller E, Schlossman R, Canning C, Mauch P, Ng A, Fisher D, Gribben J, Freeman A, Parikh B, Richardson P, Soiffer R, Ritz J, Anderson K C
Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, MA 02215, USA.
Bone Marrow Transplant. 2003 Dec;32(12):1145-51. doi: 10.1038/sj.bmt.1704289.
A total of 228 patients with multiple myeloma (MM), 166 patients receiving autologous transplantation (124 PBSC and 38 BM) and 66 patients receiving T-cell-depleted allogeneic transplantation were analyzed to compare overall survival (OS), progression-free survival (PFS) and risk of relapse. Patients receiving autologous transplantation had a significantly improved OS (P=0.006) and PFS (P=0.002) at 2 years with OS and PFS for autologous transplant 74% and 48%, respectively, compared with 51% and 28% for allogeneic transplantation. By 4 years after transplantation, outcome was similar with OS and PFS for autologous transplantation 41% and 23%, respectively, compared with 39% and 18% for allogeneic transplantation. The 4-year cumulative incidence of nonrelapse mortality was significantly higher in patients receiving allogeneic transplantation (24% vs 13%) (P=0.004). Relapse was the principle cause of treatment failure for both groups; however, there was a significantly reduced risk of relapse associated with allogeneic transplantation at 4 years: 46% for allograft vs 56% for autograft (P=0.02). Despite a lower risk of relapse after allogeneic transplantation, autologous transplantation is associated with improved OS and PFS compared with allogeneic transplantation in patients with MM. Strategies focused on reducing nonrelapse mortality in allogeneic transplantation may translate into an improved outcome for patients receiving allogeneic transplantation.
共分析了228例多发性骨髓瘤（MM）患者，其中166例接受自体移植（124例接受外周血干细胞移植和38例接受骨髓移植），66例接受T细胞去除的异基因移植，以比较总生存期（OS）、无进展生存期（PFS）和复发风险。接受自体移植的患者在2年时OS（P=0.006）和PFS（P=0.002）显著改善，自体移植的OS和PFS分别为74%和48%，而异基因移植分别为51%和28%。移植后4年时，结果相似，自体移植的OS和PFS分别为41%和23%，而异基因移植分别为39%和18%。接受异基因移植的患者4年非复发死亡率的累积发生率显著更高（24%对13%）（P=0.004）。复发是两组治疗失败的主要原因；然而，异基因移植在4年时复发风险显著降低：同种异体移植为46%，自体移植为56%（P=0.02）。尽管异基因移植后复发风险较低，但与异基因移植相比，自体移植在MM患者中与改善的OS和PFS相关。专注于降低异基因移植中非复发死亡率的策略可能会转化为接受异基因移植患者更好的结局。
