Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY.
Clin Lymphoma Myeloma Leuk. 2020 Oct;20(10):e734-e751. doi: 10.1016/j.clml.2020.05.027. Epub 2020 Jun 7.
Autologous stem cell transplantation (SCT) during the initial treatment of multiple myeloma has been shown to improve progression-free survival (PFS) but not overall survival (OS). While awaiting further prospective data, we retrospectively analyzed the outcomes of patients at our program.
We included consecutive patients with newly diagnosed myeloma who had undergone stem cell harvest (SCH) from 2005 to 2014 and separated them into early (SCT within 12 months of diagnosis) and delayed (all others, including SCT not yet) groups. The outcomes were OS, PFS to first relapse, and PFS to second relapse.
Of the 514 patients who had undergone SCH, 227 were in the early and 287 in the delayed groups. Patients in the delayed group who had undergone SCT had received more therapy before SCT (55% had received ≥ 2 lines vs. 6% in the early group; P < .001), had had more progressive disease at SCT (34% vs. 4%; P < .001), had received melphalan doses < 200 mg/m (22% vs. 10%; P = .001), and had had lower rates of very good partial response or better after SCT (58% vs. 79%; P = .001). On multivariable analysis, no differences were found in median OS (90 vs. 84 months; P = .093), PFS to first relapse (40 vs. 37 months; P = .552), or PFS to second relapse (54 vs. 52 months; P = .488) between the early and delayed groups.
Delaying SCT did not affect OS or even PFS to second relapse in our cohort of patients with newly diagnosed myeloma who had received current era induction therapy.
自体干细胞移植（SCT）在多发性骨髓瘤的初始治疗中已被证明可改善无进展生存期（PFS），但不能改善总生存期（OS）。在等待进一步的前瞻性数据的同时，我们回顾性分析了我们项目中患者的结局。
我们纳入了 2005 年至 2014 年间接受干细胞采集（SCH）的新诊断多发性骨髓瘤连续患者，并将其分为早期（诊断后 12 个月内进行 SCT）和延迟组（所有其他患者，包括尚未进行 SCT 的患者）。结局是 OS、首次复发的 PFS 和第二次复发的 PFS。
在 514 例接受 SCH 的患者中，227 例患者在早期组，287 例患者在延迟组。延迟组中接受 SCT 的患者在 SCT 前接受了更多的治疗（55%接受了≥2 线治疗，而早期组为 6%；P<0.001），在 SCT 时疾病进展更严重（34%对 4%；P<0.001），接受的美法仑剂量<200mg/m（22%对 10%；P=0.001），SCT 后获得非常好的部分缓解或更好的比例较低（58%对 79%；P=0.001）。多变量分析显示，早期组和延迟组的中位 OS（90 个月对 84 个月；P=0.093）、首次复发的 PFS（40 个月对 37 个月；P=0.552）或第二次复发的 PFS（54 个月对 52 个月；P=0.488）无差异。
在我们的新诊断多发性骨髓瘤患者队列中，接受了当前时代诱导治疗后，延迟 SCT 并未影响 OS，甚至影响第二次复发的 PFS。
