Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic.
Neoplasma. 2018 Nov 15;65(6):952-957. doi: 10.4149/neo_2018_170511N346. Epub 2018 Jun 17.
Multiple myeloma is a malignant hemato-oncological malignancy that affects up to 600 people in the Czech Republic every year. Treatment options are under constant improvement and the autologous hematopoietic cell transplantation (Tx) remains a part of treatment protocols. Despite modern drug administration, the autologous Tx keeps its irreplaceable position and when ensuring two autologous Tx, the studies confirm a survival time more than twice as long as in non-transplant patients. However, there are no standardized procedures specifying the period in between the transplantations in more detail. Within our group, we compared the total of 66 patients who were administered a double transplant. One group underwent both planned tandem autologous Tx within a median of six months and mostly achieved just partial remission (PR) and less after the first transplant and out of disease progression. The other group only underwent the second Tx within a median of up to 14 months during a progression period or disease relapse. Both groups were comparable as far as basic parameters are concerned (age, type of induction therapy and cytogenetic risk). A significantly better treatment free survival (TFX) and overall survival (OS) were observed in the group where tandem Tx was administered. TFS was 18 months and median OS was not reached for the group of patients who received tandem Tx, while TFS was 10 months (p=0.04) and median OS was 57 months (p=0.005) for those who received delayed second Tx. In the group of patients who received second Tx during relapse, we observed that TFS and OS were shorter in those with a higher paraprotein level, thus suggesting the potential role of paraprotein level as a prognostic marker. The TFS in the subgroup with a high initial level was 4 months vs. 11 months (p=0.0016) and OS 44 months vs. 65 months (p=0.03).
多发性骨髓瘤是一种恶性血液肿瘤，每年在捷克影响多达 600 人。治疗方案在不断改进，自体造血细胞移植（Tx）仍然是治疗方案的一部分。尽管使用了现代药物，但自体 Tx 仍然具有不可替代的地位，两次自体 Tx 可确保患者的生存时间比非移植患者长两倍以上。然而，目前尚无标准化程序来更详细地规定两次移植之间的时间间隔。在我们的研究组中，我们比较了 66 名接受双移植的患者。一组在中位时间为 6 个月内进行了两次计划的串联自体 Tx，大多数患者仅获得部分缓解（PR），第一次移植后缓解率较低，且疾病进展后缓解率更低。另一组仅在进展期或疾病复发期间在中位时间长达 14 个月内进行第二次 Tx。两组在基本参数方面（年龄、诱导治疗类型和细胞遗传学风险）具有可比性。在接受串联 Tx 的组中观察到显著更好的无治疗生存期（TFX）和总生存期（OS）。接受串联 Tx 的患者组 TFS 为 18 个月，中位 OS 未达到，而接受延迟第二次 Tx 的患者组 TFS 为 10 个月（p=0.04），中位 OS 为 57 个月（p=0.005）。在接受第二次 Tx 治疗复发的患者组中，我们观察到那些具有较高的 M 蛋白水平的患者 TFS 和 OS 更短，这表明 M 蛋白水平可能作为预后标志物。初始水平较高的亚组 TFS 为 4 个月，11 个月（p=0.0016），OS 为 44 个月，65 个月（p=0.03）。
