Krejci Marta, Scudla Vlastimil, Tothova Elen, Schutzova Miroslava, Koza Vladimir, Adam Zdenek, Krivanova Andrea, Pour Ludek, Buchler Tomas, Sandecka Viera, Kralova Dana, Zahradova Lenka, Vorlicek Jiri, Mayer Jiri, Hajek Roman
Department of Internal Medicine - Hematooncology, Masaryk University Hospital, Jihlavska 20, 625 00 Brno, Czech Republic.
Clin Lymphoma Myeloma. 2009 Dec;9(6):436-42. doi: 10.3816/CLM.2009.n.086.
Autologous stem cell transplantation (autoSCT) has an important role in the treatment of patients with symptomatic multiple myeloma (MM). Treatment options for myeloma have expanded in the past decade, and it seems that patients who are treated with novel drugs such as thalidomide and bortezomib for relapse after autoSCT have longer overall survival (OS).
Herein, we describe the long-term outcome of a cohort of 185 patients with newly diagnosed MM treated with autoSCT. We have analyzed factors that might predict for long-term survival.
Following autoSCT, the overall response rate was 94% (173 of 185 patients); 29% (53 of 185 patients) were in complete remission (CR). Median time to progression (TTP) and OS from start of therapy were 39.8 months and 77.9 months, respectively. The median follow-up was 103.8 months (range, 60.8-144.8 months); 23% of the patients are alive and disease free, 21% of the patients are alive with relapse, and 56% of the patients have died. On multivariate analysis, factors associated with significantly better OS were International Staging System (ISS) disease stage < III (hazard ratio [HR], 2.6; P < .001), achievement of CR after autoSCT (HR, 2.8; P < .001) and use of thalidomide (HR, 4.3; P < .001) and/or bortezomib (HR, 7.3; P < .001) in posttransplantation relapse treatment. The patients' age, renal impairment, disease status before autoSCT and maintenance therapy with interferon-alpha (IFN-alpha) or IFN-alpha and dexamethasone did not significantly affect TTP and OS after transplantation.
According to our results, the achievement of CR after transplantation, ISS stage other than III, and administration of thalidomide or bortezomib in posttransplantation relapse were significant parameters favoring long-term posttransplantation survival.
自体干细胞移植（autoSCT）在有症状的多发性骨髓瘤（MM）患者的治疗中具有重要作用。在过去十年中，骨髓瘤的治疗选择有所增加，似乎自体干细胞移植后复发接受沙利度胺和硼替佐米等新药治疗的患者总生存期（OS）更长。
在此，我们描述了一组185例接受自体干细胞移植治疗的新诊断MM患者的长期预后情况。我们分析了可能预测长期生存的因素。
自体干细胞移植后，总缓解率为94%（185例患者中的173例）；29%（185例患者中的53例）达到完全缓解（CR）。从治疗开始的中位进展时间（TTP）和总生存期分别为39.8个月和77.9个月。中位随访时间为103.8个月（范围60.8 - 144.8个月）；23%的患者存活且无疾病，21%的患者复发后存活，56%的患者死亡。多因素分析显示，与总生存期显著更好相关的因素包括国际分期系统（ISS）疾病分期<III期（风险比[HR]，2.6；P <.001）、自体干细胞移植后达到CR（HR，2.8；P <.001）以及在移植后复发治疗中使用沙利度胺（HR，4.3；P <.001）和/或硼替佐米（HR，7.3；P <.001）。患者的年龄、肾功能损害、自体干细胞移植前的疾病状态以及使用干扰素-α（IFN-α）或干扰素-α与地塞米松进行维持治疗对移植后的TTP和总生存期没有显著影响。
根据我们的结果，移植后达到CR、ISS分期非III期以及在移植后复发时使用沙利度胺或硼替佐米是有利于移植后长期生存的重要参数。
