Department of Hematology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, #505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea.
Int J Hematol. 2013 May;97(5):634-9. doi: 10.1007/s12185-013-1311-2. Epub 2013 Apr 20.
To examine the role of high-dose melphalan therapy with autologous stem cell transplantation (HDM/ASCT) in the final outcomes of multiple myeloma (MM) patients receiving bortezomib-containing induction therapy (IT), we analyzed relationships between quality of response after IT including bortezomib or HDM/ASCT and survival. In total, 92 MM patients who received IT with bortezomib followed by HDM/ASCT were enrolled. The median follow-up was 28.0 months. Three-year progression-free survival (PFS) and overall survival (OS) were 41.1 and 72.0 %, respectively. A complete response (CR) after HDM/ASCT was a strong prognostic factor for PFS and OS (p = 0.002 and 0.001, respectively). Additionally, out of 67 patients who failed to achieve CR after IT, 36 (53.7 %) patients achieved CR after HDM/ASCT. PFS and OS in patients with CR after additional HDM/ASCT were similar to those in patients who had already achieved CR after IT. However, achievement of at least very good partial response following IT with bortezomib failed to improve PFS and OS (p = 0.35 and 0.11, respectively). Thus, we conclude that post-HDM/ASCT CR is the best prognostic factor for both PFS and OS regardless of response to bortezomib. Therefore, HDM/ASCT remains an important therapy in MM patients even after introduction of bortezomib IT.
为了研究在接受硼替佐米联合含硼替佐米的诱导治疗（IT）的多发性骨髓瘤（MM）患者中，大剂量美法仑联合自体干细胞移植（HDM/ASCT）治疗在最终结局中的作用，我们分析了 IT 后反应质量（包括硼替佐米或 HDM/ASCT）与生存之间的关系。共纳入 92 例接受硼替佐米 IT 后行 HDM/ASCT 的 MM 患者。中位随访时间为 28.0 个月。3 年无进展生存（PFS）和总生存（OS）分别为 41.1%和 72.0%。ASCT 后达到完全缓解（CR）是 PFS 和 OS 的强烈预后因素（p = 0.002 和 0.001）。此外，在 67 例 IT 后未能达到 CR 的患者中，有 36 例（53.7%）患者在 HDM/ASCT 后达到 CR。在接受额外 HDM/ASCT 后达到 CR 的患者中，PFS 和 OS 与已经在 IT 后达到 CR 的患者相似。然而，在接受硼替佐米 IT 后至少达到非常好的部分缓解并不能改善 PFS 和 OS（p = 0.35 和 0.11）。因此，我们得出结论，ASCT 后达到 CR 是 PFS 和 OS 的最佳预后因素，与硼替佐米的反应无关。因此，即使在引入硼替佐米 IT 后，HDM/ASCT 仍然是 MM 患者的重要治疗方法。
