Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea.
Korean J Intern Med. 2011 Mar;26(1):76-81. doi: 10.3904/kjim.2011.26.1.76. Epub 2011 Mar 2.
BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment.
We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (≥ 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (≥ 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS).
During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp ≥ 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp ≥ 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp ≥ 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters.
Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.
背景/目的：自体干细胞移植（ASCT）已成为多发性骨髓瘤（MM）患者的首选治疗方法。研究表明，ASCT 后干扰素-α维持治疗可提高生存率。然而，尽管这些方案最近取得了进展，但复发是不可避免的；因此，需要评估 ASCT 后的复发预测。
我们回顾性分析了 2003 年至 2008 年间接受 ASCT 的 39 例患者。所有患者均接受长春新碱、阿霉素和地塞米松（VAD）化疗，在高剂量马法兰预处理后进行 ASCT。我们评估了移植后第 14 天（D+14）骨髓浆细胞百分比（BMPCp）（≥2% vs. <2%）、国际分期系统（ISS）分期（II 期 vs. III 期）、VAD 治疗 3 个周期后的反应（完全缓解[CR] vs. 非 CR）、13q 缺失（del[13q]）（异常存在 vs. 不存在）和诊断时 BMPCp（≥50% vs. <50%）对无进展生存期（PFS）和总生存期（OS）的影响。
在中位随访 28.0 个月期间，中位 PFS 和 OS 分别为 29.1 和 42.1 个月。单因素分析显示，诊断时 ISS 分期 III 期、诊断时 BMPCp≥50%、VAD 治疗 3 个周期后 CR、荧光原位杂交检测到 13q 缺失和移植后 D+14 时 BMPCp≥2%与 PFS 和 OS 相关。多因素分析显示，移植后 D+14 时 BMPCp≥2%（PFS，风险比[HR]=4.426，p=0.008；OS，HR=3.545，p=0.038）和 VAD 治疗 3 个周期后 CR（PFS，HR=0.072，p=0.014；OS，HR=0.055，p=0.015）是独立的预后参数。
移植后 D+14 时 BMPCp 是预测接受 ASCT 的 MM 患者结局的有用参数。
