Sahebi F, Iacobelli S, Biezen A V, Volin L, Dreger P, Michallet M, Ljungman P T, de Witte T, Henseler A, Schaap N P M, López-Corral L, Poire X, Passweg J, Hamljadi R-M, Thomas S H, Schonland S, Gahrton G, Morris C, KrÖger N, Garderet L
1] City of Hope, Duarte, CA, USA [2] Southern California Kaiser Permanente, Los Angeles, CA, USA.
Università Tor Vergata, Roma, Italy.
Bone Marrow Transplant. 2015 Jun;50(6):802-7. doi: 10.1038/bmt.2015.45. Epub 2015 Mar 23.
We performed a retrospective analysis of the European Group for Blood and Marrow Transplantation database comparing the outcomes of multiple myeloma patients who received tandem autologous followed by allogeneic PSCT (auto-allo) with the outcomes of patients who underwent a reduced intensity conditioning allograft (early RIC) without prior autologous transplant. From 1996 to 2013, we identified a total of 690 patients: 517 patients were planned to receive auto-allo and 173 received an early RIC allograft without prior autologous transplant. With a median follow-up of 93 months, 5-year PFS survival was significantly better in the auto-allo group, 34% compared with 22% in the early RIC group (P<0.001). OS was also significantly improved in the auto-allo group with a 5-year rate of 59% vs 42% in the early RIC group (P=0.001). The non-relapse mortality rate was lower in the auto-allo group than in the early RIC group, with 1- and 3-year rates of 8% and 13% vs 20% and 28%, respectively (P<0.001). The relapse/progression rate was similar in the two groups, with 5-year rates of 50% for auto-allo and 46% for early RIC (P=0.42). These data suggest that planned tandem autologous allograft can improve overall survival compared with upfront RIC allograft alone in patients with multiple myeloma.
我们对欧洲血液与骨髓移植组数据库进行了回顾性分析，比较接受序贯自体移植后异基因外周血干细胞移植（自体-异基因移植）的多发性骨髓瘤患者与未进行过自体移植而接受减低剂量预处理异基因移植（早期减低剂量预处理）的患者的预后。从1996年至2013年，我们共纳入690例患者：517例患者计划接受自体-异基因移植，173例患者接受了未进行过自体移植的早期减低剂量预处理异基因移植。中位随访时间为93个月，自体-异基因移植组的5年无进展生存率显著更高，分别为34%和22%（P<0.001）。自体-异基因移植组的总生存率也显著提高，5年生存率为59%，而早期减低剂量预处理组为42%（P=0.001）。自体-异基因移植组的非复发死亡率低于早期减低剂量预处理组，1年和3年非复发死亡率分别为8%和13%，而早期减低剂量预处理组分别为20%和28%（P<0.001）。两组的复发/进展率相似，自体-异基因移植组和早期减低剂量预处理组的5年复发/进展率分别为50%和46%（P=0.42）。这些数据表明，对于多发性骨髓瘤患者，计划进行的序贯自体移植与单纯早期减低剂量预处理异基因移植相比，可提高总生存率。
