Jin Lina, Fu Weijun, Xi Hao, Zhang Chunyang, Du Juan, He Haiyan, Jiang Hua, Zeng Tianmei, Fan Jianling, Zhou Lili, Chang Hong, Hou Jian
Department of Hematology, The Myeloma and Lymphoma Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200003, China.
Zhonghua Xue Ye Xue Za Zhi. 2016 Jan;37(1):14-9. doi: 10.3760/cma.j.issn.0253-2727.2016.01.003.
To explore the efficacy and prognostic factors of induction therapy combined with autogenetic peripheral blood stem cells transplantation (APBSCT)in patients with multiple myeloma (MM).
From January 1998 to May 2015, 201 patients with MM were enrolled. All patients received APBSCT after induction therapy. With the follow up to 20 June 2015, the overall survival (OS), progression free survival (PFS)and prognostic factor were analyzed.
① With a media follow up of 36.67 months, the median PFS and OS were 22.87 (17.48- 28.26)and 69.63 (63.57- 75.69)months, 5-year PFS and OS were 17% and 49%, respectively. ②After APBSCT, when the subgroup (n= 112) achieved complete response (CR)compared with the subgroup (n=89) not achieved CR, the median PFS were 32.93 (21.03-44.83) and 18.13 (14.46-21.80) months (P<0.001), respectively; And the media OS were 96.77 (71.79- 121.75)and 54.70 (49.53- 59.87) months (P=0.004), respectively. The risks for disease progression and death declined in CR subgroup. ③ Two subgroups included or not included bortezomib/thalidomide at induction therapy (123 patientsvs 21 patients), the media PFS were 31.67 (24.36- 38.98)and 15.20 (10.11- 20.29) months (P=0.013), respectively; And the media OS were 76.30 (55.44- 97.15)and 52.03 (33.76- 70.30) months (P=0.014), respectively. ④According to the ISS stage, the media OS of stageⅠ, Ⅱ, Ⅲ were 99.47 (59.58-139.36), 66.77 (52.17-81.37), 53.97 (28.71-79.23) (P< 0.001), respectively. The risk for death of stage Ⅱ, Ⅲ were 2.16 and 3.04 times higher than stage Ⅰ, with no difference in terms of PFS. ⑤ The media PFS in IgD (n=22) and IgG (n=101) type MM were 11.17 (10.27- 13.13)and 35.43 (22.69- 48.17)months (P=0.007) , respectively; The media OS were 30.83 (0.24-61.42)and 70.70 (53.52-87.88) months (P=0.039), respectively. The risk for disease progression of IgD type was 2.47 times higher than IgG type. ⑥ Patients received 1 line induction therapy (n=132) compared with more than 1 line (n=69), the media PFS were 25.43 (16.09- 34.77)and 20.27 (15.04- 25.50) months (P=0.042). ⑦Cox analysis showed that CR after APBSCT and ISS stage were independent prognostic factors for OS. IgD type MM and CR after APBSCT were independent prognosis factor for PFS.
CR after APBSCT and ISS stage were independent prognostic factors for OS in MM. CR after APBSCT was independent prognostic factor for PFS in MM. However, disease progression more likely occurred in IgD type MM, which was independent negative prognostic factor for PFS in MM.
探讨诱导治疗联合自体外周血干细胞移植（APBSCT）治疗多发性骨髓瘤（MM）患者的疗效及预后因素。
选取1998年1月至2015年5月期间收治的201例MM患者。所有患者在诱导治疗后接受APBSCT。随访至2015年6月20日，分析总生存期（OS）、无进展生存期（PFS）及预后因素。
①中位随访时间为36.67个月，中位PFS和OS分别为22.87（17.48 - 28.26）个月和69.63（63.57 - 75.69）个月，5年PFS和OS分别为17%和49%。②APBSCT后，达到完全缓解（CR）的亚组（n = 112）与未达到CR的亚组（n = 89）相比，中位PFS分别为32.93（21.03 - 44.83）个月和18.13（14.46 - 21.80）个月（P < 0.001）；中位OS分别为96.77（71.79 - 121.75）个月和54.70（49.53 - 59.87）个月（P = 0.00）。CR亚组疾病进展和死亡风险降低。③诱导治疗时包含或不包含硼替佐米/沙利度胺的两个亚组（123例对21例），中位PFS分别为31.67（24.36 - 38.98）个月和15.20（10.11 - 20.29）个月（P = 0.013）；中位OS分别为76.30（55.44 - 97.15）个月和52.03（33.76 - 70.30）个月（P = 0.014）。④根据国际分期系统（ISS）分期，Ⅰ期、Ⅱ期、Ⅲ期的中位OS分别为99.47（59.58 - 139.36）个月、66.77（52.17 - 81.37）个月、53.97（28.71 - 79.23）个月（P < 0.001）。Ⅱ期、Ⅲ期死亡风险分别是Ⅰ期的2.16倍和3.04倍，PFS无差异。⑤IgD型（n = 22）和IgG型（n = 101）MM的中位PFS分别为11.17（10.27 - 13.13）个月和35.43（22.69 - 48.17）个月（P = 0.007）；中位OS分别为30.83（0.24 - 61.42）个月和70.70（53.52 - 87.88）个月（P = 0.039）。IgD型疾病进展风险是IgG型的2.47倍。⑥接受1线诱导治疗的患者（n = 132）与接受超过1线诱导治疗的患者（n = 69）相比，中位PFS分别为25.43（16.09 - 34.77）个月和20.27（15.04 - 25.50）个月（P = 0.042）。⑦Cox分析显示，APBSCT后的CR和ISS分期是OS的独立预后因素。APBSCT后的CR是MM患者PFS的独立预后因素。然而，IgD型MM更易发生疾病进展，是MM患者PFS的独立负性预后因素。
