Zannetti Beatrice Anna, Tacchetti Paola, Pantani Lucia, Gamberi Barbara, Tosi Patrizia, Rocchi Serena, Cellini Claudia, Ronconi Sonia, Pezzi Annalisa, Mancuso Katia, Rizzello Ilaria, Caratozzolo Isola, Martello Marina, Dozza Luca, Cavo Michele, Zamagni Elena
"Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
Hematology Unit, "Arcispedale Santa Maria Nuova - IRCCS" Hospital, Reggio Emilia, Italy.
Ann Hematol. 2017 Dec;96(12):2071-2078. doi: 10.1007/s00277-017-3140-5. Epub 2017 Oct 24.
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Therapeutic options for patients with relapsed MM after ASCT include novel agents in different combos, salvage ASCT (sASCT), and allogeneic transplant, with no unique standard of care. We retrospectively analyzed 66 MM patients who relapsed after up-front single or double ASCT(s) and received novel agent-based sASCT at five Italian centers. Median event-free survival from up-front ASCT(s) to first relapse (EFS1) was 44 months. Seventy-three percent of patients received sASCT at first disease progression. Re-induction regimens were bortezomib based in 87% of patients. Response to re-induction therapy included complete response (CR) 18%, ≥ very good partial response (VGPR) 48%, and overall response rate (ORR) 83%. Response to sASCT included CR 44%, ≥ VGPR 77%, and ORR 94%. With a median follow-up of 24 months after sASCT, 39 patients experienced disease progression. Median EFS from sASCT (EFS2) was 17 months. Median overall survival from ASCT (OS1) and sASCT (OS2) was 166 and 43 months, respectively. EFS2 and OS2 were significantly shorter in patients with EFS1 ≤ 24 months, in patients who did not receive sASCT at first disease progression and in patients with extramedullary disease (EMD). In multivariate analysis, EFS1 ≤ 24 months was associated with shorter EFS2 and OS2, EMD was associated with shorter EFS2, and < CR after sASCT was associated with shorter OS2. Novel agent-based sASCT is a safe and effective procedure for relapsed MM.
大剂量化疗后进行自体干细胞移植（ASCT）是多发性骨髓瘤（MM）的标准一线治疗方法。ASCT后复发的MM患者的治疗选择包括不同组合的新型药物、挽救性ASCT（sASCT）和异基因移植，尚无独特的标准治疗方案。我们回顾性分析了66例在初次进行单次或双次ASCT后复发并在意大利五个中心接受基于新型药物的sASCT的MM患者。从初次ASCT到首次复发的无事件生存期（EFS1）中位数为44个月。73%的患者在疾病首次进展时接受了sASCT。87%的患者再诱导方案以硼替佐米为基础。再诱导治疗的缓解情况包括完全缓解（CR）18%、≥非常好的部分缓解（VGPR）48%以及总缓解率（ORR）83%。sASCT的缓解情况包括CR 44%、≥VGPR 77%以及ORR 94%。sASCT后中位随访24个月时，39例患者疾病进展。sASCT后的EFS中位数（EFS2）为17个月。ASCT（OS1）和sASCT（OS2）后的总生存期中位数分别为166个月和43个月。EFS1≤24个月的患者、在疾病首次进展时未接受sASCT的患者以及有髓外疾病（EMD）的患者，其EFS2和OS2显著缩短。多因素分析显示，EFS1≤24个月与较短的EFS2和OS2相关，EMD与较短的EFS2相关，sASCT后未达到CR与较短的OS2相关。基于新型药物的sASCT对于复发MM是一种安全有效的治疗方法。
