Dingli David, Pacheco Jorge M, Dispenzieri Angela, Hayman Suzanne R, Kumar Shaji K, Lacy Martha Q, Gastineau Dennis A, Gertz Morie A
Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Cancer Sci. 2007 Jul;98(7):1035-40. doi: 10.1111/j.1349-7006.2007.00499.x. Epub 2007 May 4.
High dose therapy with autologous stem cell transplantation (HDT-ASCT) has prolonged survival in patients with multiple myeloma. Patients who achieve a complete response (CR) benefit the most from this form of therapy. Thus, achieving a CR is an important goal of therapy and it will be beneficial if the probability of achieving CR can be determined for any patient before transplant. Here we report that pretransplant monoclonal protein level (M-spike) was found to be an important predictor. Thus, we used knowledge of the rate of M-protein production by myeloma cells together with the clearance of the protein to estimate the pretransplant disease burden. We show that the pretransplant disease burden, based on the M-spike, is the only predictor for achieving CR. A simple function that describes this probability is presented. We also provide an estimate of the rate of tumor regrowth in patients who obtain a CR and in patients who only get a partial response with HDT-ASCT. The significant expansion of myeloma cells after HDT-ASCT is clearly evident. Clinical trials must be designed that take into account these kinetic aspects of the disease.
高剂量自体干细胞移植疗法（HDT-ASCT）延长了多发性骨髓瘤患者的生存期。达到完全缓解（CR）的患者从这种治疗形式中获益最大。因此，实现CR是治疗的一个重要目标，如果在移植前就能为任何患者确定实现CR的概率，将会很有帮助。在此我们报告，移植前单克隆蛋白水平（M峰）被发现是一个重要的预测指标。因此，我们利用骨髓瘤细胞产生M蛋白的速率以及该蛋白的清除情况来估计移植前的疾病负担。我们表明，基于M峰的移植前疾病负担是实现CR的唯一预测指标。给出了一个描述这种概率的简单函数。我们还对接受HDT-ASCT后达到CR的患者以及仅获得部分缓解的患者的肿瘤再生速率进行了估计。HDT-ASCT后骨髓瘤细胞的显著扩增显而易见。必须设计考虑到该疾病这些动力学方面的临床试验。
