Dipartimento di Ematologia e Onco-Ematologia Pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Università degli Studi di Milano, Dipartimento di Oncologia ed Emato-Oncologia, Milan, Italy.
Bone Marrow Transplant. 2017 Dec;52(12):1602-1608. doi: 10.1038/bmt.2017.183. Epub 2017 Sep 11.
We evaluated 71 patients treated with allogeneic hematopoietic cell transplantation (allo-HCT) for multiple myeloma (MM). Forty-three patients (61%) received allo-HCT after the first line of therapy. Fifty-eight patients (82%) had chemosensitive disease at the time of allo-HCT. A HLA-matched related or unrelated donor was available for 68 patients (96%). Non-myeloablative or reduced-intensity conditioning regimen and peripheral blood hematopoietic cells as a graft source were used in most patients. The cumulative incidence of grade II-IV acute GVHD at day +100 and chronic GVHD at 5 years was 13% (95% CI 7-23%) and 35% (95% CI 24-46), respectively. Non-relapse mortality and relapse/progression incidence at 5 years were 12% (95% CI 5-23) and 65% (95% CI 49-76), respectively. With a median follow-up in survivors of 100 months (range 16-186), the 5-year PFS and OS were 39% (95% CI 27-52) and 60% (95% CI 55-77), respectively. On multivariate analysis: age >55 years was associated with both a reduced PFS (RR 2.11, 95% CI 1.15-3.87) and OS (RR 5.53, 95% CI 2.22-13.76); chemorefractory disease at allo-HCT was associated with both reduced PFS (RR 3.09, 95% CI 1.37-7.00) and OS (RR 3.19, 95% CI 1.23-8.22). At relapse, 24 patients (56%) received bortezomib, 28 (65%) lenalidomide, 11 (26%) pomalidomide, 16 (37%) donor lymphocytes infusion as part of salvage therapy after allo-HCT relapse. Median PFS from time of salvage treatment was 7 months (range 0-113 months) for bortezomib-based therapy, 14 months (range 0-79 months) for lenalidomide and 10 months (range 1-28) for pomalidomide. Allo-HCT is a feasible and effective strategy in selected patients with MM and could be an effective platform for subsequent therapies.
我们评估了 71 例接受异基因造血细胞移植（allo-HCT）治疗多发性骨髓瘤（MM）的患者。43 例患者（61%）在一线治疗后接受 allo-HCT。58 例患者（82%）在 allo-HCT 时患有化疗敏感疾病。68 例患者（96%）有 HLA 匹配的亲缘或无关供体。大多数患者采用非清髓或减低强度预处理方案和外周血造血细胞作为移植物来源。第 100 天的 II-IV 级急性移植物抗宿主病和 5 年慢性移植物抗宿主病的累积发生率分别为 13%（95%CI 7-23%）和 35%（95%CI 24-46%）。5 年非复发死亡率和复发/进展发生率分别为 12%（95%CI 5-23%）和 65%（95%CI 49-76%）。在幸存者的中位随访 100 个月（范围 16-186）中，5 年无进展生存率和总生存率分别为 39%（95%CI 27-52%）和 60%（95%CI 55-77%）。多变量分析显示：年龄>55 岁与无进展生存率（RR 2.11，95%CI 1.15-3.87）和总生存率（RR 5.53，95%CI 2.22-13.76）降低相关；allo-HCT 时化疗耐药疾病与无进展生存率（RR 3.09，95%CI 1.37-7.00）和总生存率（RR 3.19，95%CI 1.23-8.22）降低相关。在复发时，24 例患者（56%）接受硼替佐米、28 例患者（65%）接受来那度胺、11 例患者（26%）接受泊马度胺、16 例患者（37%）接受供者淋巴细胞输注作为 allo-HCT 后挽救治疗的一部分。基于硼替佐米的治疗从挽救治疗开始的中位无进展生存率为 7 个月（范围 0-113 个月），基于来那度胺的治疗为 14 个月（范围 0-79 个月），基于泊马度胺的治疗为 10 个月（范围 1-28 个月）。allo-HCT 是一种在选择的 MM 患者中可行且有效的策略，并且可以作为后续治疗的有效平台。
