Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Blood. 2010 Mar 25;115(12):2348-53; quiz 2560. doi: 10.1182/blood-2009-07-235531. Epub 2010 Jan 20.
Autologous stem cell transplantation as a platform for multiple myeloma treatment is the standard of care for patients who can safely withstand the procedure. Before novel agents were introduced, one-third to one-half of patients did not achieve partial response at transplantation. Previous medical literature has shown that in this past era, absence of initial response to induction therapy had no impact on progression-free survival and overall survival after high-dose therapy. Lack of response to initial induction did not preclude a good response after stem cell transplantation. With the introduction of novel agents-immunomodulatory drugs and proteasome inhibitors-response rates with initial therapy are now between 70% and 100%. This retrospective study analyzes progression-free survival and overall survival in patients who do not have a partial response (never responded or progressed during continuous therapy) after induction therapy with a regimen that contains thalidomide or lenalidomide. Unlike patients in reports published previously-before immunomodulatory drugs-patients who do not achieve partial remission have a significantly shorter overall survival from transplantation (73.5 vs 30.4 months) and a shorter progression-free survival (22.1 vs 13.1 months; P < .001). Absence of a response to induction therapy with thalidomide or lenalidomide predicts a poorer outcome after high-dose therapy.
自体干细胞移植作为多发性骨髓瘤治疗的平台，是能够安全耐受该治疗的患者的护理标准。在新型药物问世之前，三分之一至一半的患者在移植时未达到部分缓解。既往医学文献表明，在过去的这个时期，诱导治疗无初始反应与大剂量治疗后的无进展生存期和总生存期无关。初始诱导无反应并不排除干细胞移植后的良好反应。随着新型药物——免疫调节剂和蛋白酶体抑制剂的引入，初始治疗的反应率现在在 70%至 100%之间。这项回顾性研究分析了接受含有沙利度胺或来那度胺的方案诱导治疗后无部分缓解（连续治疗期间从未缓解或进展）患者的无进展生存期和总生存期。与免疫调节剂药物问世之前发表的报告中的患者不同，未达到部分缓解的患者从移植开始的总生存期（73.5 个月比 30.4 个月）和无进展生存期（22.1 个月比 13.1 个月；P<.001）明显更短。沙利度胺或来那度胺诱导治疗无反应预测大剂量治疗后预后较差。
