Shouval Roni, Teper Omer, Fein Joshua A, Danylesko Ivetta, Shem Tov Noga, Yerushalmi Ronit, Avigdor Abraham, Vasilev Elena, Magen Hila, Nagler Arnon, Shimoni Avichai
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.
Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
Bone Marrow Transplant. 2020 Sep;55(9):1736-1743. doi: 10.1038/s41409-020-0829-1. Epub 2020 Feb 17.
Allogeneic hematopoietic stem cell transplantation (allo-SCT) may offer a cure for selected patients with multiple myeloma (MM). Effective prognostic markers to guide patient selection are warranted. We retrospectively studied a cohort of 100 relapsed refractory MM patients who underwent allo-SCT. With a median follow-up of 12.2 years, median overall survival (OS) and progression-free survival (LFS) were 9.2 months and 5.6 months, respectively. 5-years OS and PFS were was 18.0% and 16.8%. The cumulative incidence of 5-years relapse was 45.9% and non-relapse mortality (NRM) 36.0%. In a multivariable Cox model, decreasing albumin, increasing lactate dehydrogenase (LDH), advanced disease, and mismatched donors were predictive of both reduced OS and PFS. The probability of 5-years OS was higher in patients with LDH below vs. the upper limit of normal (22% vs. 5%, p = 0.004). In the multivariable analysis, the hazard of NRM was increased with low albumin, mismatched donor type, and declining estimated glomerular filtration rate (eGFR). Patients with a low eGFR had a 5-year NRM incidence of 31% vs. 56% in patients with higher levels (p = 0.02). Graft-versus-host disease was not associated with improved outcomes. In conclusion, LDH, renal function, and albumin are highly informative of outcomes in MM patients treated with allo-SCT.
异基因造血干细胞移植（allo-SCT）可能为部分多发性骨髓瘤（MM）患者提供治愈机会。因此，需要有效的预后标志物来指导患者选择。我们对100例接受allo-SCT的复发难治性MM患者进行了回顾性研究。中位随访12.2年，中位总生存期（OS）和无进展生存期（LFS）分别为9.2个月和5.6个月。5年OS率和PFS率分别为18.0%和16.8%。5年复发累积发生率为45.9%，非复发死亡率（NRM）为36.0%。在多变量Cox模型中，白蛋白降低、乳酸脱氢酶（LDH）升高、疾病进展和供体不匹配是OS和PFS降低的预测因素。LDH低于正常上限的患者5年OS概率高于LDH高于正常上限的患者（22%对5%，p = 0.004）。在多变量分析中，低白蛋白、供体类型不匹配和估计肾小球滤过率（eGFR）下降会增加NRM风险。eGFR低的患者5年NRM发生率为31%，而eGFR高的患者为56%（p = 0.02）。移植物抗宿主病与预后改善无关。总之，LDH、肾功能和白蛋白对接受allo-SCT治疗的MM患者的预后具有重要指示意义。
