O'Shea D, Giles C, Terpos E, Perz J, Politou M, Sana V, Naresh K, Lampert I, Samson D, Narat S, Kanfer E, Olavarria E, Apperley J F, Rahemtulla A
Department of Haematology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, UK.
Bone Marrow Transplant. 2006 Apr;37(8):731-7. doi: 10.1038/sj.bmt.1705307.
High-dose therapy with autologous stem cell therapy (ASCT) has become the treatment of choice for eligible patients with myeloma. We analysed retrospectively the prognostic influence of pre-transplant characteristics and transplant modalities on response and survival in 211 myeloma patients who were transplanted in our centre between 1994 and 2004. All patients received peripheral blood stem cell support after conditioning with melphalan alone (183 patients), or melphalan and total blood irradiation (28 patients). We evaluated the influence of age, type of multiple myeloma, status prior and post ASCT, previous treatment regimens, time of ASCT from diagnosis, year of autograft, dose of re-infused CD34(+) cells, plasma cell infiltration and beta2-microglobulin at diagnosis on overall survival (OS) and event-free survival (EFS) to define patients with better prognosis. Median OS and EFS from transplantation were 50.9 and 20.1 months, respectively. Median OS from diagnosis was 68.8 months. Transplant-related mortality was 1.4%. Lower beta2-microglobulin levels, achievement of complete remission (CR) post transplant and lower plasma cell infiltration at diagnosis and transplant correlated with longer EFS and OS, whereas CR at transplant and low international prognostic index at transplant correlated with better EFS. Higher CD34(+) cell dose correlated with improved OS. We conclude that ASCT is safe and effective and the outcome is independent of age, time from diagnosis, previous treatment and conditioning regimen.
大剂量自体干细胞疗法（ASCT）已成为符合条件的骨髓瘤患者的首选治疗方法。我们回顾性分析了1994年至2004年间在本中心接受移植的211例骨髓瘤患者移植前特征和移植方式对反应及生存的预后影响。所有患者在单用美法仑（183例患者）或美法仑与全身照射（28例患者）预处理后接受外周血干细胞支持。我们评估了年龄、多发性骨髓瘤类型、ASCT前后状态、既往治疗方案、从诊断到ASCT的时间、自体移植年份、回输的CD34(+)细胞剂量、诊断时的浆细胞浸润和β2-微球蛋白对总生存期（OS）和无事件生存期（EFS）的影响，以确定预后较好的患者。移植后的中位OS和EFS分别为50.9个月和20.1个月。从诊断开始的中位OS为68.8个月。移植相关死亡率为1.4%。较低的β2-微球蛋白水平、移植后达到完全缓解（CR）以及诊断和移植时较低的浆细胞浸润与更长的EFS和OS相关，而移植时的CR和移植时较低的国际预后指数与更好的EFS相关。较高的CD34(+)细胞剂量与改善的OS相关。我们得出结论，ASCT是安全有效的，其结果与年龄、从诊断开始的时间、既往治疗和预处理方案无关。
