Wang Chen, Soekojo Cinnie Yentia, Mel Sanjay de, Ooi Melissa, Chen Yunxin, Goh Allan Zhi Kai, Nagarajan Chandramouli, Chng Wee Joo
Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore.
Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore.
Cancers (Basel). 2020 Jul 2;12(7):1759. doi: 10.3390/cancers12071759.
The prognosis of multiple myeloma has considerably improved due to the introduction of novel agents in the upfront setting. However, the great majority of patients ultimately relapse, and choosing a salvage treatment at first relapse remains challenging. The natural history of first relapsed disease in the current era is also not well described. We retrospectively studied 300 patients with first relapsed myeloma seen between 2004 and 2019 from two institutes in Singapore. The median duration from diagnosis to first relapse was 22.7 months (1.1-97.0 months). Most patients received novel agent-based induction therapy, and 41.3% underwent autologous stem cell transplant. A very good partial response (VGPR) or better was achieved in 48.6%. Regarding first relapse, 50.5% were symptomatic and 19.0% received newer agent-containing regimens. Nearly a third of patients (31.7%) had a VGPR or better response. The median progression free and overall survival from first relapse was 12.0 and 44.8 months, respectively. Based on a randomized sample splitting, we first identified non-hyperdiploid karyotype at diagnosis, clinical relapse, and treatment sequence as impacting survival independently from a testing cohort, and we then further demonstrated their significance in a validation cohort. This study provides a real-world picture of first relapsed myeloma and highlights the prognostic importance of the treatment sequence.
由于在初始治疗中引入了新型药物，多发性骨髓瘤的预后有了显著改善。然而，绝大多数患者最终会复发，在首次复发时选择挽救治疗仍然具有挑战性。当前时代首次复发疾病的自然史也尚未得到充分描述。我们回顾性研究了2004年至2019年间在新加坡两家机构就诊的300例首次复发的骨髓瘤患者。从诊断到首次复发的中位持续时间为22.7个月（1.1 - 97.0个月）。大多数患者接受了基于新型药物的诱导治疗，41.3%的患者接受了自体干细胞移植。48.6%的患者达到了非常好的部分缓解（VGPR）或更好的缓解。关于首次复发，50.5%的患者有症状，19.0%的患者接受了含新型药物的方案。近三分之一的患者（31.7%）有VGPR或更好的反应。首次复发后的中位无进展生存期和总生存期分别为12.0个月和44.8个月。基于随机样本拆分，我们首先在一个测试队列中确定诊断时的非超二倍体核型、临床复发和治疗顺序对生存有独立影响，然后在一个验证队列中进一步证明了它们的重要性。这项研究提供了首次复发骨髓瘤的真实情况，并强调了治疗顺序的预后重要性。
