Muta Tsuyoshi, Miyamoto Toshihiro, Kamimura Tomohiko, Kanda Yoshinobu, Nohgawa Masaharu, Ueda Yasunori, Iwato Koji, Sasaki Osamu, Mori Takehiko, Uchida Naoyuki, Iida Shinsuke, Fukuda Takahiro, Atsuta Yoshiko, Sunami Kazutaka
Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kita-Kyushu, Japan.
Acta Haematol. 2018;139(1):35-44. doi: 10.1159/000484652. Epub 2018 Jan 17.
Autologous stem cell transplantation (ASCT) has been employed for patients with relapsed multiple myeloma (MM) after up-front ASCT. The present retrospective study aimed to examine the survival benefit from salvage ASCT. Among 446 patients with relapsed MM after up-front single ASCT, 70 patients received salvage ASCT, the employment of which reduced the risk of mortality after relapse (p = 0.041). Using the parameters before initial ASCT, the advantage of salvage ASCT compared to standard therapy was confirmed in the subgroup with an international staging system stage of I or II (p = 0.040), good performance status (PS; p = 0.043), or no/mild renal comorbidity (p = 0.029). The advantage of salvage ASCT was also confirmed in the subgroup excluding those with early relapse within 7 months after initial ASCT (p = 0.026). Among patients who received salvage ASCT, a favorable prognosis is apparent for those with a time to relapse after initial ASCT of longer than 24 months. The overall survival after salvage ASCT was favorable excluding patients with the following factors: early relapse, poor PS, moderate/severe renal comorbidity, and progressive disease (p < 0.001). In conclusion, our results reinforced the evidence for encouraging salvage ASCT for eligible patients.
自体干细胞移植（ASCT）已用于初次ASCT后复发的多发性骨髓瘤（MM）患者。本回顾性研究旨在探讨挽救性ASCT的生存获益。在446例初次单次ASCT后复发的MM患者中，70例接受了挽救性ASCT，其应用降低了复发后的死亡风险（p = 0.041）。利用初次ASCT前的参数，在国际分期系统分期为I或II期（p = 0.040）、体能状态良好（PS；p = 0.043）或无/轻度肾脏合并症（p = 0.029）的亚组中，证实了挽救性ASCT相对于标准治疗的优势。在排除初次ASCT后7个月内早期复发的患者亚组中，也证实了挽救性ASCT的优势（p = 0.026）。在接受挽救性ASCT的患者中，初次ASCT后复发时间超过24个月的患者预后良好。排除以下因素的患者后，挽救性ASCT后的总生存期良好：早期复发、PS差、中度/重度肾脏合并症和疾病进展（p < 0.001）。总之，我们的结果强化了鼓励符合条件的患者进行挽救性ASCT的证据。
