Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia.
Intern Med J. 2013 Feb;43(2):156-61. doi: 10.1111/j.1445-5994.2012.02867.x.
Multiple myeloma is incurable despite the advance of autologous stem cell transplant (ASCT) and novel agents (thalidomide, bortezomib, lenalidomide). The role of ASCT as salvage therapy in relapsed myeloma remains unclear.
To identify and refine the predictors of survival following salvage ASCT for relapsed multiple myeloma, so that they can be applied clinically for patient selection.
Retrospective review of patients treated salvage ASCT for relapsed myeloma at our centre from 1992 to 2011.
Following an initial ASCT at diagnosis, 30 patients underwent salvage ASCT for subsequent relapse, with the median time to first relapse/progression being 30.2 months. All patients received reinduction, then melphalan-based conditioning with salvage ASCT. Non-relapse mortality at 100 days following salvage ASCT was 3%. The median overall survival and progression-free survival following salvage ASCT were 45 and 22 months respectively. The progression-free interval (PFI) after initial ASCT predicted survival outcomes in a time-dependent manner. With PFI following initial ASCT of <18, 18-36 and ≥36 months, the median progression-free survival following salvage ASCT was 4.2, 13.8 and 49.1 months respectively (P < 0.0001). The median overall survival was 10.7, 30.9 and 86.1 months respectively (P < 0.0001).
Salvage ASCT is an effective and safe treatment option in selected patients and should be considered in patients relapsing ≥36 months after their initial ASCT. The time-dependent relationship between PFI and salvage ASCT outcome is important when stratifying patient groups who may benefit from this procedure.
尽管自体干细胞移植 (ASCT) 和新型药物（沙利度胺、硼替佐米、来那度胺）的进步，多发性骨髓瘤仍然无法治愈。ASCT 作为复发性骨髓瘤的挽救性治疗的作用仍不清楚。
确定并完善复发性多发性骨髓瘤患者接受 ASCT 挽救治疗后的生存预测因素，以便将其应用于临床患者选择。
回顾性分析本中心 1992 年至 2011 年接受 ASCT 挽救治疗的复发性骨髓瘤患者。
在诊断时进行了初始 ASCT 后，30 例患者因随后的复发而接受了 ASCT 挽救治疗，首次复发/进展的中位时间为 30.2 个月。所有患者均接受了再诱导治疗，然后接受基于美法仑的预处理，随后进行 ASCT 挽救治疗。ASCT 挽救治疗后 100 天的非复发死亡率为 3%。ASCT 挽救治疗后的中位总生存期和无进展生存期分别为 45 个月和 22 个月。初始 ASCT 后的无进展间隔 (PFI) 以时间依赖的方式预测生存结果。初始 ASCT 后 PFI<18、18-36 和≥36 个月的患者，ASCT 挽救治疗后的中位无进展生存期分别为 4.2、13.8 和 49.1 个月（P<0.0001）。中位总生存期分别为 10.7、30.9 和 86.1 个月（P<0.0001）。
ASCT 挽救治疗是一种有效且安全的治疗选择，适用于某些患者，对于初始 ASCT 后≥36 个月复发的患者，应考虑使用 ASCT 挽救治疗。在分层接受该治疗程序的患者群体时，PFI 与 ASCT 治疗结果之间的时间依赖性关系很重要。
