Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancer. 2012 Jul 15;118(14):3549-55. doi: 10.1002/cncr.26662. Epub 2011 Nov 15.
High-dose chemotherapy with autologous hematopoietic cell transplant (auto-HCT) has been shown to improve survival in patients with newly diagnosed multiple myeloma. However, the role of salvage auto-HCT for relapsed patients, particularly in the era of novel therapeutics, is not well defined.
The authors performed a retrospective analysis of all 44 myeloma patients (24 men, 20 women) who received a second auto-HCT as salvage between January 3, 1992 and November 4, 2008 at The University of Texas MD Anderson Cancer Center.
Median interval between the first and salvage auto-HCT was 30 months (range, 2-78 months). Median age at salvage HCT was 54 years (range, 38-73 years), and median number of salvage treatment regimens was 2 (range, 0-5). Eleven (25%) patients had high-risk chromosomal abnormalities on conventional cytogenetic studies between diagnosis and salvage auto-HCT. Ten patients (23%) experienced grade 3 or higher nonhematologic toxicity after the salvage auto-HCT. One patient died within 100 days, for a treatment-related mortality of 2%. Best responses after salvage chemotherapy + salvage auto-HCT were as follows: complete response (CR) + near CR, 11%; partial response, 79%; overall response rate, 90%. Eighteen (41%) patients received post auto-HCT maintenance therapy. Median follow-up from salvage HCT was 41 months. Kaplan-Meier estimates of median progression-free survival (PFS) and overall survival (OS) from time of salvage auto-HCT were 12.3 and 31.7 months, respectively. Median OS from the time of diagnosis was 75 months. In a fitted Bayesian multivariate model, shorter time to progression after first auto-HCT, greater number of prior therapies, African American race, and immunoglobulin G subtype were significantly associated with worse OS.
In selected myeloma patients, a second auto-HCT for salvage therapy is well tolerated, with acceptable toxicity. The overall response rate and PFS are comparable to other salvage regimens.
高剂量化疗联合自体造血细胞移植（auto-HCT）已被证明可提高新诊断多发性骨髓瘤患者的生存率。然而，在新型治疗药物时代，挽救性 auto-HCT 对复发患者的作用尚不确定。
作者对 1992 年 1 月 3 日至 2008 年 11 月 4 日期间在德克萨斯大学 MD 安德森癌症中心接受第二次挽救性 auto-HCT 的 44 例骨髓瘤患者（24 例男性，20 例女性）进行了回顾性分析。
第一次和挽救性 auto-HCT 之间的中位间隔为 30 个月（范围 2-78 个月）。挽救性 HCT 时的中位年龄为 54 岁（范围 38-73 岁），中位挽救性治疗方案数为 2 个（范围 0-5 个）。在诊断和挽救性 auto-HCT 之间的常规细胞遗传学研究中，11 例（25%）患者存在高危染色体异常。10 例（23%）患者在挽救性 auto-HCT 后出现 3 级或更高的非血液学毒性。1 例患者在 100 天内死亡，治疗相关死亡率为 2%。挽救性化疗+挽救性 auto-HCT 后的最佳反应如下：完全缓解（CR）+接近 CR，11%；部分缓解，79%；总缓解率为 90%。18 例（41%）患者接受了 auto-HCT 后维持治疗。从挽救性 HCT 开始的中位随访时间为 41 个月。从挽救性 auto-HCT 开始的中位无进展生存期（PFS）和总生存期（OS）的 Kaplan-Meier 估计值分别为 12.3 个月和 31.7 个月。从诊断开始的中位 OS 为 75 个月。在拟合的贝叶斯多变量模型中，首次 auto-HCT 后进展时间较短、治疗次数较多、非裔美国人种族和免疫球蛋白 G 亚型与较差的 OS 显著相关。
在选择的骨髓瘤患者中，第二次用于挽救治疗的自体 HCT 耐受性良好，毒性可接受。总体反应率和 PFS 与其他挽救方案相当。
