Center for Hematologic Malignancy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Geyonggi, 410-769, Republic of Korea.
Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Int J Hematol. 2020 Jul;112(1):84-95. doi: 10.1007/s12185-020-02869-y. Epub 2020 May 25.
Autologous stem cell transplantation (ASCT) is not frequently performed for elderly patients multiple myeloma (MM) in Korea, despite its being a standardized approach for young patients. Medical records of 150 patients from 15 Korean institutions who received ASCT at age ≥ 64 years were analyzed retrospectively. Patients included had symptomatic MM, and had received their first ASCT at age ≥ 64 following induction chemotherapy. The main outcome was the response after ASCT. Overall survival (OS) and progression-free survival (PFS) were also analyzed. Median time to ASCT was 6.3 months. Complete response plus stringent complete response rate increased from 36 (24.0%) to 105 (70.0%) after ASCT, and high-quality response (≥ very good partial response) increased from 96 (64.0%) to 125 (83.3%). With a median follow-up of 32.6 months after ASCT, 5-year OS and PFS were 59.7% and 22.8%, respectively. Febrile neutropenia occurred in 43.5%, and nausea (21.3%) and stomatitis (13.2%) were common grade 3-4 non-hematologic adverse events. Of 44 deaths, disease progression (n = 23) was the most common cause of mortality, followed by infection (n = 13). Treatment-related death occurred in four cases (2.7%). ASCT is an effective and safe option for elderly MM patients and is associated with superior clinical outcomes.
自体干细胞移植（ASCT）在韩国并不常用于老年多发性骨髓瘤（MM）患者，尽管它是年轻患者的标准治疗方法。回顾性分析了来自 15 家韩国机构的 150 名年龄≥64 岁接受 ASCT 的患者的病历。这些患者均患有有症状的 MM，并在年龄≥64 岁时接受了诱导化疗后的首次 ASCT。主要终点是 ASCT 后的反应。还分析了总生存期（OS）和无进展生存期（PFS）。ASCT 的中位时间为 6.3 个月。完全缓解加严格完全缓解率从 ASCT 前的 36 例（24.0%）增加到 105 例（70.0%），高质量缓解（≥非常好的部分缓解）从 96 例（64.0%）增加到 125 例（83.3%）。在 ASCT 后中位随访 32.6 个月时，5 年 OS 和 PFS 分别为 59.7%和 22.8%。发热性中性粒细胞减少症的发生率为 43.5%，常见的 3-4 级非血液学不良事件有恶心（21.3%）和黏膜炎（13.2%）。44 例死亡中，疾病进展（n=23）是最常见的死亡原因，其次是感染（n=13）。有 4 例（2.7%）与治疗相关的死亡。ASCT 是老年 MM 患者的一种有效且安全的选择，可获得更好的临床结局。
