Kumar Sk, Dingli D, Dispenzieri A, Lacy Mq, Hayman S R, Buadi Fk, Rajkumar Sv, Litzow Mr, Gertz Ma
Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Bone Marrow Transplant. 2008 Aug;42(4):259-64. doi: 10.1038/bmt.2008.166. Epub 2008 Jun 16.
Reported results of high-dose therapy (HDT) reflect the combined effect of initial therapy and HDT. The incremental contribution of HDT is often difficult to analyze with varying degrees of response pre-HDT. Here we analyze results of HDT in patients with measurable disease at transplant, defined as a serum or 24 h urine M protein of >1.0 g per 100 ml and >200 mg per day, respectively. Paraprotein responses were calculated using measurements prior to HDT and the lowest subsequent measurement. A total of 431 patients were studied; 264 (61.3%) transplanted within 1-year of diagnosis. An additional reduction in paraprotein by 50% following HDT was seen in 86% patients; with 129 patients (30%) obtaining a 90% reduction. Patients with at least a 90% reduction had longer time to progression with no overall survival advantage and this was independent of other prognostic factors for decreased risk of progression. This study provides an estimate of the degree of tumor reduction provided by HDT, in addition to that provided by the initial therapy. In this group of patients with measurable disease after initial therapy, HDT therapy leads to complete responses in nearly a quarter of the patients and a 90% reduction in another 7%, an outcome associated with better progression-free survival.
高剂量疗法（HDT）的报告结果反映了初始疗法和HDT的联合效果。由于HDT前存在不同程度的反应，HDT的增量贡献往往难以分析。在此，我们分析了移植时患有可测量疾病患者的HDT结果，可测量疾病定义为血清或24小时尿M蛋白分别>1.0 g/100 ml和>200 mg/天。副蛋白反应通过HDT前的测量值和随后的最低测量值来计算。共研究了431例患者；264例（61.3%）在诊断后1年内进行了移植。86%的患者在HDT后副蛋白额外降低了50%；129例患者（30%）降低了90%。副蛋白至少降低90%的患者疾病进展时间更长，但无总体生存优势，且这与其他降低疾病进展风险的预后因素无关。本研究除了评估初始疗法所带来的肿瘤缩小程度外，还评估了HDT所带来的肿瘤缩小程度。在这组初始治疗后患有可测量疾病的患者中，HDT疗法使近四分之一的患者获得完全缓解，另外7%的患者副蛋白降低了90%，这一结果与更好的无进展生存期相关。
