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自体干细胞移植治疗多发性骨髓瘤:预后因素的鉴定。

Autologous stem cell transplantation for multiple myeloma: identification of prognostic factors.

机构信息

Department of Medical Oncology, Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Clin Lymphoma Myeloma Leuk. 2013 Feb;13(1):32-41. doi: 10.1016/j.clml.2012.08.007. Epub 2012 Oct 22.

DOI:10.1016/j.clml.2012.08.007
PMID:23085487
Abstract

INTRODUCTION

The purpose of this study was to evaluate the effect of prognostic factors on the outcome of patients with MM after ASCT.

PATIENTS AND METHODS

We analyzed results of 170 consecutive patients (121 male and 49 female) of MM who underwent ASCT. Patients' median age was 52 years (range, 26-68 years). High dose melphalan (200 mg/m(2)) was used for conditioning. One hundred thirty-two patients (77.6%) had evidence of chemosensitive disease before transplant. Response was assessed using European Group for Blood and Bone Marrow Transplantation criteria.

RESULTS

Post ASCT 44.7% of patients achieved CR, 24.7% had very good partial response (VGPR), and 21.2% had partial response (PR). Presence of pretransplant chemosensitive disease (CR, VGPR, and PR) and transplant within 12 months of diagnosis for years before 2006 were associated with higher response rates on multivariate analysis. At a median follow-up of 84 months, median overall (OS) and event-free survival (EFS) is 85.5 and 41 months, respectively. Estimated OS and EFS at 60 months is 62 ± 0.04% and 41 ± 0.04%, respectively. Patients who responded to transplant (CR, VGPR, and PR) had a longer OS (P < .001) and EFS (P < .001). Additionally, patients who achieved CR post transplant had a longer OS (P < .001) and EFS (P < .001). Patients who received novel agents for induction pretransplant had a longer OS (P < .001) and EFS (P < .002).

CONCLUSION

Outcome after ASCT is better for myeloma patients with pretransplant chemosensitive disease and those who achieve CR after transplant.

摘要

简介

本研究旨在评估预后因素对接受 ASCT 后 MM 患者结局的影响。

患者与方法

我们分析了 170 例连续 MM 患者(男 121 例,女 49 例)接受 ASCT 的结果。患者中位年龄为 52 岁(范围,26-68 岁)。高剂量美法仑(200mg/m²)用于预处理。132 例(77.6%)患者在移植前有化疗敏感疾病的证据。使用欧洲血液和骨髓移植组标准评估反应。

结果

ASCT 后,44.7%的患者达到完全缓解(CR),24.7%有非常好的部分缓解(VGPR),21.2%有部分缓解(PR)。移植前化疗敏感疾病(CR、VGPR 和 PR)和 2006 年前的诊断后 12 个月内进行移植与多变量分析中更高的反应率相关。在中位随访 84 个月时,中位总生存(OS)和无事件生存(EFS)分别为 85.5 和 41 个月。60 个月时的估计 OS 和 EFS 分别为 62 ± 0.04%和 41 ± 0.04%。对移植有反应(CR、VGPR 和 PR)的患者具有更长的 OS(P<0.001)和 EFS(P<0.001)。此外,移植后达到 CR 的患者具有更长的 OS(P<0.001)和 EFS(P<0.001)。移植前接受新型药物诱导的患者具有更长的 OS(P<0.001)和 EFS(P<0.002)。

结论

移植前化疗敏感疾病和移植后达到 CR 的 MM 患者 ASCT 后的结局更好。

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