Elice Francesca, Raimondi Roberto, Tosetto Alberto, D'Emilio Anna, Di Bona Eros, Piccin Andrea, Rodeghiero Francesco
Department of Hematology, San Bortolo Hospital, Vicenza, Italy.
Am J Hematol. 2006 Jun;81(6):426-31. doi: 10.1002/ajh.20641.
Between August 1993 and March 2003, 130 consecutive multiple myeloma (MM) patients eligible for high-dose treatment were offered a program including up-front autologous stem cell transplantation (ASCT) after conditioning with 200 mg/m(2) melphalan followed by a second ASCT in case of relapse or progression. A total of 107 (82%) patients completed the first ASCT. The best response obtained after ASCT was complete response (CR) 23%, very good partial response (VGPR) 28%, partial response (PR) 42%, and minimal response (MR) 7%. Median overall survival (OS) and event-free survival (EFS) were 65.4 and 27.7 months, respectively. Relapse or progression occurred in 70 patients; 26 received a second ASCT (with a median time of 20.4 months from first ASCT). A major response (> or =PR) was obtained in 69% of these patients. Median OS and EFS after the second ASCT were 38.1 and 14.8 months. Treatment-related mortality was 1.9% after the first ASCT but no deaths occurred after the second. Our experience suggests that elective up-front single ASCT followed by second ASCT after relapse or progression is a safe and effective global strategy to treat MM patients.
1993年8月至2003年3月期间，130例符合高剂量治疗条件的多发性骨髓瘤（MM）患者接受了一个治疗方案，该方案包括在接受200mg/m²美法仑预处理后进行前期自体干细胞移植（ASCT），复发或进展时进行第二次ASCT。共有107例（82%）患者完成了首次ASCT。ASCT后获得的最佳缓解为完全缓解（CR）23%、非常好的部分缓解（VGPR）28%、部分缓解（PR）42%和最小缓解（MR）7%。中位总生存期（OS）和无事件生存期（EFS）分别为65.4个月和27.7个月。70例患者出现复发或进展；26例接受了第二次ASCT（从首次ASCT起的中位时间为20.4个月）。这些患者中有69%获得了主要缓解（≥PR）。第二次ASCT后的中位OS和EFS分别为38.1个月和14.8个月。首次ASCT后的治疗相关死亡率为1.9%，但第二次ASCT后无死亡发生。我们的经验表明，复发或进展后进行选择性前期单次ASCT然后进行第二次ASCT是治疗MM患者的一种安全有效的整体策略。
