Dingli David, Nowakowski Grzegorz S, Dispenzieri Angela, Lacy Martha Q, Hayman Suzanne, Litzow Mark R, Gastineau Dennis A, Gertz Morie A
Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Clin Lymphoma Myeloma. 2006 Mar;6(5):384-8. doi: 10.3816/CLM.2006.n.014.
Patients with multiple myeloma who undergo autologous stem cell transplantation (ASCT) and exhibit a complete response (CR) have a superior overall survival and time to progression (TTP). High-dose cyclophosphamide is often used before ASCT for mobilization of hematopoietic stem cells. We hypothesized that cyclophosphamide might further improve CR rates in patients undergoing ASCT. We searched the Mayo Clinic myeloma transplantation database for patients who had stem cell mobilization with hematopoietic growth factor alone or cyclophosphamide and growth factor. The impact of cyclophosphamide on CR rates and TTP was evaluated.
A cohort of 201 patients was identified: 127 mobilized with cyclophosphamide and growth factor and 74 with growth factor alone. There were no statistically significant differences between the 2 cohorts in regard to age, sex, b2-microglobulin level, plasma cell labeling index, cytogenetics, conditioning regimen, or disease status at time of transplantation.
Complete response rates were 37.4% and 41.3% (P = 0.6115) for patients mobilized with cyclophosphamide combined with growth factor and growth factor alone, respectively, and TTPs were 19.9 months and 20.9 months (P = 0.59). In a multivariate analysis for TTP, cytogenetics and CR rates were the only independent variables (P = 0.0012 and P < 0.0001, respectively).
We conclude that high-dose cyclophosphamide does not increase overall CR rates or improve TTP for patients with myeloma undergoing ASCT.
接受自体干细胞移植（ASCT）且表现出完全缓解（CR）的多发性骨髓瘤患者具有更好的总生存期和无进展生存期（TTP）。大剂量环磷酰胺常用于ASCT前动员造血干细胞。我们假设环磷酰胺可能会进一步提高接受ASCT患者的CR率。我们在梅奥诊所骨髓瘤移植数据库中搜索了仅使用造血生长因子或使用环磷酰胺和生长因子进行干细胞动员的患者。评估了环磷酰胺对CR率和TTP的影响。
确定了一组201例患者：127例使用环磷酰胺和生长因子进行动员，74例仅使用生长因子进行动员。两组在年龄、性别、β2-微球蛋白水平、浆细胞标记指数、细胞遗传学、预处理方案或移植时的疾病状态方面无统计学显著差异。
使用环磷酰胺联合生长因子和仅使用生长因子进行动员的患者，其完全缓解率分别为37.4%和41.3%（P = 0.6115），TTP分别为19.9个月和20.9个月（P = 0.59）。在TTP的多变量分析中，细胞遗传学和CR率是仅有的独立变量（分别为P = 0.0012和P < 0.0001）。
我们得出结论，大剂量环磷酰胺不会提高接受ASCT的骨髓瘤患者的总体CR率或改善TTP。
