Hospital Universitario 12 de Octubre, Madrid, Spain.
Blood. 2011 Jul 21;118(3):529-34. doi: 10.1182/blood-2011-01-332320. Epub 2011 Apr 11.
For establishing the true effect of different response categories in patients with multiple myeloma (MM) treated with autologous stem cell transplantation, we evaluated, after a median follow-up of 153 months, 344 patients with MM who received a transplant between 1989 and 1998. Overall survival (OS) at 12 years was 35% in complete response (CR) patients, 22% in near complete response (nCR), 16% in very good partial response (VGPR), and 16% in partial response (PR) groups. Significant differences in OS and progression-free survival were found between CR and nCR groups (P = .01 and P = .002, respectively), between CR and VGPR groups (P = .0001 and P = .003), or between CR and PR groups (P = .003 and P = < 10(-5)); no differences were observed between the nCR and VGPR groups (P = .2 and P = .9) or between these groups and the PR group (P = .1 and P = .8). A landmark study found a plateau phase in OS after 11 years; 35% patients in the CR group and 11% in the nCR+VGPR+PR group are alive at 17 years; 2 cases had relapsed in the nCR+VGPR+PR group. In conclusion, MM achieving CR after autologous stem cell transplantation is a central prognostic factor. The relapse rate is low in patients with > 11 years of follow-up, possibly signifying a cure for patients in CR.
为了确定自体干细胞移植治疗多发性骨髓瘤(MM)患者不同反应类别的确切效果,我们对 1989 年至 1998 年期间接受移植的 344 例 MM 患者进行了中位随访 153 个月后评估。完全缓解(CR)患者的 12 年总生存率(OS)为 35%,接近完全缓解(nCR)组为 22%,非常好的部分缓解(VGPR)组为 16%,部分缓解(PR)组为 16%。CR 与 nCR 组(P =.01 和 P =.002)、CR 与 VGPR 组(P =.0001 和 P =.003)或 CR 与 PR 组(P =.003 和 P < 10(-5))之间的 OS 和无进展生存期存在显著差异;nCR 与 VGPR 组之间(P =.2 和 P =.9)或这些组与 PR 组之间(P =.1 和 P =.8)无差异。一项里程碑式研究发现,OS 在 11 年后出现平台期;CR 组 35%的患者和 nCR+VGPR+PR 组 11%的患者在 17 年后仍存活;nCR+VGPR+PR 组有 2 例复发。总之,自体干细胞移植后达到 CR 的 MM 是一个重要的预后因素。在随访 11 年以上的患者中,复发率较低,这可能意味着 CR 患者已治愈。
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