Vij Ravi, Kumar Shaji, Zhang Mei-Jie, Zhong Xiaobo, Huang Jiaxing, Dispenzieri Angela, Abidi Muneer H, Bird Jennifer M, Freytes César O, Gale Robert Peter, Kindwall-Keller Tamila L, Kyle Robert A, Landsburg Daniel J, Lazarus Hillard M, Munker Reinhold, Roy Vivek, Sharma Manish, Vogl Dan T, Wirk Baldeep, Hari Parameswaran N
Division of Hematology and Oncology, Washington University Medical School, St. Louis, Missouri.
Department of Hematology, Mayo Clinic, Rochester, Minnesota.
Biol Blood Marrow Transplant. 2015 Feb;21(2):335-41. doi: 10.1016/j.bbmt.2014.10.023. Epub 2014 Nov 1.
Patients with multiple myeloma (MM) who are eligible for autologous stem cell transplantation (ASCT) typically receive a finite period of initial therapy before ASCT. It is not clear if patients with suboptimal (less than a partial) response to initial therapy benefit from additional alternative therapy with intent to maximize pretransplant response. We identified 539 patients with MM who had an ASCT after having achieved less than a partial response (PR) to first-line induction chemotherapy between 1995 and 2010. These patients were then divided into 2 groups: those who received additional salvage chemotherapy before ASCT (n = 324) and those who had no additional salvage chemotherapy immediately before ASCT (n = 215). Additional pretransplant chemotherapy resulted in deepening responses in 68% (complete response in 8% and PR in 60%). On multivariate analysis there was no impact of pretransplant salvage chemotherapy on treatment-related mortality, risk for relapse, progression-free survival, or overall survival. In conclusion, for patients achieving less than a PR to initial induction therapy, including with novel agent combinations, additional pre-ASCT salvage chemotherapy improved the depth of response and pre-ASCT disease status but was not associated with survival benefit.
适合自体干细胞移植（ASCT）的多发性骨髓瘤（MM）患者通常在ASCT前接受一段有限时间的初始治疗。对于初始治疗反应欠佳（未达到部分缓解）的患者，额外进行替代治疗以最大化移植前反应是否有益尚不清楚。我们纳入了539例在1995年至2010年间对一线诱导化疗反应未达到部分缓解（PR）后接受ASCT的MM患者。这些患者随后被分为两组：在ASCT前接受额外挽救化疗的患者（n = 324）和在ASCT前未接受额外挽救化疗的患者（n = 215）。额外的移植前化疗使68%的患者反应加深（8%完全缓解，60%部分缓解）。多因素分析显示，移植前挽救化疗对治疗相关死亡率、复发风险、无进展生存期或总生存期均无影响。总之，对于初始诱导治疗未达到PR的患者，包括使用新型药物组合治疗的患者，ASCT前额外的挽救化疗可改善反应深度和移植前疾病状态，但与生存获益无关。
