Department of Hematology, The First Affiliated Hospital, SunYat-sen University, Guangzhou 510080, China.
Chin J Cancer Res. 2013 Apr;25(2):166-74. doi: 10.3978/j.issn.1000-9604.2013.02.02.
In our study, we determined the efficacy of bortezomib-based induction therapy followed by autologous stem cell transplant (ASCT) in newly diagnosed and relapsed/refractory (R/R) multiple myeloma (MM) patients and compared the advantages of early versus late transplant. We used a retrospective analysis to examine 62 patients, including 46 cases of newly diagnosed MM (early transplant group) and 16 cases of relapsed/refractory MM (late transplant group). All of these patients received bortezomib-based induction therapy followed by ASCT. The efficacy and side effects of the treatment regimen were analyzed. Patients' overall survival (OS) and progression-free survival (PFS) times were determined. The ratio of complete remission to near-complete remission (CR/nCR) was 69.5% versus 56.2% (P=0.361), respectively, for the early transplant group versus the late transplant group, respectively, after receiving bortezomib-based induction therapy; the overall response rates of the two group were 91.3% and 81.2%, respectively (P=0.369). After receiving ASCT, the CR/nCR of the two groups increased to 84.8% and 81.3%, respectively. The median time required for neutrophil engraftment of the early transplant group and the late transplant group was 11 and 14.5 days, respectively (P=0.003); the median time required for platelet engraftment was 13 and 21.5 days (P=0.031), respectively. There were no significant differences in the toxic side effects observed during induction therapy and ASCT between the two groups. The OS of the two groups was not statistically different (P=0.058). The PFS of the early transplant group and the late transplant group was 41.6 and 26.5 months, respectively (P=0.008). Multivariate analysis demonstrated that the time of receiving ASCT, the types of M protein, and the International Staging System (ISS) stage were all independent factors that influenced PFS. In conclusion, patients in a suitable condition for ASCT should be recommended to have an early ASCT immediately after diagnosis.
在我们的研究中，我们确定了硼替佐米为基础的诱导治疗联合自体干细胞移植（ASCT）在新诊断和复发/难治性（R/R）多发性骨髓瘤（MM）患者中的疗效，并比较了早期与晚期移植的优势。我们使用回顾性分析来检查 62 名患者，包括 46 例新诊断的 MM（早期移植组）和 16 例复发/难治性 MM（晚期移植组）。所有这些患者均接受硼替佐米为基础的诱导治疗，然后进行 ASCT。分析了治疗方案的疗效和副作用。确定患者的总生存期（OS）和无进展生存期（PFS）。接受硼替佐米为基础的诱导治疗后，早期移植组和晚期移植组的完全缓解率至接近完全缓解率（CR/nCR）分别为 69.5%和 56.2%（P=0.361），两组的总缓解率分别为 91.3%和 81.2%（P=0.369）。接受 ASCT 后，两组的 CR/nCR 分别增加到 84.8%和 81.3%。早期移植组和晚期移植组中性粒细胞植入的中位时间分别为 11 天和 14.5 天（P=0.003）；血小板植入的中位时间分别为 13 天和 21.5 天（P=0.031）。两组诱导治疗和 ASCT 期间观察到的毒性副作用无显著差异。两组的 OS 无统计学差异（P=0.058）。早期移植组和晚期移植组的 PFS 分别为 41.6 和 26.5 个月（P=0.008）。多变量分析表明，接受 ASCT 的时间、M 蛋白类型和国际分期系统（ISS）分期均是影响 PFS 的独立因素。总之，对于适合 ASCT 的患者，建议在诊断后立即进行早期 ASCT。
