Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, NSW, Australia.
Leuk Lymphoma. 2011 Sep;52(9):1727-35. doi: 10.3109/10428194.2011.582201.
This study reports on the outcome of 95 allogeneic hematopoietic cell transplants (HCTs) using reduced intensity conditioning (RIC) performed for patients with multiple myeloma (MM) in Australia and New Zealand between 1998 and 2006. The median age at HCT was 52 years. Of the 32 patients for whom the allograft was performed as a first transplant, 15 (47%) had their allograft less than 1 year from diagnosis, while for the 63 patients who had an allograft following an autograft, nine (14%) were allografted within 1 year post-diagnosis (p < 0.001). The cumulative incidence of transplant-related mortality (TRM) was 19% at 1 year post-transplant. At 5 years post-transplant the overall survival (OS) was 40% and progression-free survival (PFS) was 23%, with no apparent survival plateau. Three factors were independently favorable predictors of OS in a Cox regression model: immunoglobulin G (IgG) myeloma (hazard ratio [HR] = 0.42, 95% confidence interval [CI] 0.24-0.75, p = 0.004), a human leukocyte antigen (HLA)-identical sibling donor (HR = 0.37, 95% CI 0.18-0.74, p = 0.005), and less than 1 year between MM diagnosis and RIC HCT (HR = 0.27, 95% CI 0.12-0.59, p = 0.001). Patterns of outcome indicate that RIC HCT may offer the potential for cure for only a small group of patients with MM.
本研究报告了 1998 年至 2006 年间澳大利亚和新西兰的 95 例多发性骨髓瘤（MM）患者接受减强度预处理（RIC）异基因造血细胞移植（HCT）的结果。HCT 时的中位年龄为 52 岁。在 32 例接受同种异体移植的患者中，有 15 例（47%）在诊断后不到 1 年内进行同种异体移植，而在 63 例接受自体移植后进行同种异体移植的患者中，有 9 例（14%）在诊断后 1 年内进行同种异体移植（p < 0.001）。移植相关死亡率（TRM）在移植后 1 年时为 19%。移植后 5 年时，总生存率（OS）为 40%，无进展生存率（PFS）为 23%，无明显生存平台。在 Cox 回归模型中，有 3 个因素是 OS 的独立有利预测因素：免疫球蛋白 G（IgG）骨髓瘤（风险比[HR] = 0.42，95%置信区间[CI] 0.24-0.75，p = 0.004）、人类白细胞抗原（HLA）-完全匹配的同胞供体（HR = 0.37，95%CI 0.18-0.74，p = 0.005）和 MM 诊断与 RIC HCT 之间少于 1 年（HR = 0.27，95%CI 0.12-0.59，p = 0.001）。结果模式表明，RIC HCT 可能仅为一小部分 MM 患者提供治愈的潜力。
