Dingli David, Pacheco Jorge M, Nowakowski Grzegorz S, Kumar Shaji K, Dispenzieri Angela, Hayman Suzanne R, Lacy Martha Q, Gastineau Dennis A, Gertz Morie A
Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
J Clin Oncol. 2007 Nov 1;25(31):4933-7. doi: 10.1200/JCO.2007.11.7879.
High-dose therapy with autologous stem-cell transplantation (HDT-ASCT) is now almost standard therapy for many patients with multiple myeloma, partly because of higher complete response (CR) rates. Some studies suggest that tandem transplantation gives superior results. The aim of this study was to determine whether the depth of the response to HDT-ASCT leads to an improvement in time to progression (TTP) and overall survival (OS). We hypothesized that patients with CR before HDT-ASCT (BCR) will have their disease burden reduced further and experience a longer TTP and perhaps OS.
All patients who achieved BCR or CR after HDT-ASCT (ACR) were identified. The characteristics and long-term outcome of these patients were evaluated.
We identified 14 patients with BCR and 103 patients with ACR who were treated in similar fashion. The patients have been followed for more than 6 years, and the median for OS has not been reached (60-month survival, 55% for BCR and 63% for ACR; P = .83). The median TTP was 43 months for BCR and 34 months for ACR (P = .39).
The depth of the response in myeloma does not necessarily lead to an improvement in TTP and OS. Tumor dynamics considerations show that the yield from sequential cycles of chemotherapy decreases. Patients who achieve CR with the first transplant can be safely observed without jeopardizing OS.
高剂量自体干细胞移植（HDT-ASCT）目前几乎已成为许多多发性骨髓瘤患者的标准治疗方法，部分原因是其完全缓解（CR）率较高。一些研究表明，串联移植效果更佳。本研究旨在确定HDT-ASCT的缓解深度是否会改善疾病进展时间（TTP）和总生存期（OS）。我们假设HDT-ASCT前达到CR（BCR）的患者疾病负担将进一步减轻，TTP更长，甚至OS也更长。
确定所有在HDT-ASCT后达到BCR或CR（ACR）的患者。评估这些患者的特征和长期预后。
我们确定了14例BCR患者和103例ACR患者，他们接受了相似的治疗。患者随访超过6年，OS中位数未达到（60个月生存率，BCR为55%，ACR为63%；P = 0.83）。BCR患者的TTP中位数为43个月，ACR患者为34个月（P = 0.39）。
骨髓瘤的缓解深度不一定会改善TTP和OS。肿瘤动力学研究表明，序贯化疗周期的获益会降低。首次移植即达到CR的患者可安全观察，而不会危及OS。
