MedStar Georgetown University Hospital, Washington, DC.
John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
Cancer. 2020 Dec 1;126(23):5077-5087. doi: 10.1002/cncr.33171. Epub 2020 Sep 23.
Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults.
The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori.
An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m . On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty.
The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
upfront 自体造血干细胞移植（AHCT）仍然是多发性骨髓瘤（MM）患者治疗的重要方法，MM 是一种老年疾病。
作者研究了≥70 岁 MM 患者 AHCT 的结果。美国国际血液和骨髓移植研究中心（CIBMTR）数据库在 2013 年至 2017 年期间登记了 15999 例在美国确诊后 12 个月内的 MM 患者；共有 2092 例患者年龄≥70 岁。非复发死亡率（NRM）、疾病复发和/或进展（relapse；REL）、无进展生存期（PFS）和总生存期（OS）采用 Cox 比例风险模型进行建模，移植时的年龄为主要因素。由于样本量较大，预先认为 P 值<.01 具有统计学意义。
与 2013 年（15%）相比，≥70 岁患者的 AHCT 在 2017 年有所增加（28%）。尽管总体上约 82%的患者接受了美法仑（Mel）剂量为 200mg/m2，但 58%的≥70 岁患者接受了 Mel 剂量为 140mg/m2。多变量分析显示，≥70 岁患者的 NRM（危险比 [HR] 1.3；99%置信区间 [99%CI]，1-1.7 [P=0.06]）、REL（HR，1.03；99%CI，0.9-1.1 [P=0.6]）、PFS（HR，1.06；99%CI，1-1.2 [P=0.2]）和 OS（HR，1.2；99%CI，1-1.4 [P=0.02]）与参考组（年龄 60-69 岁）相比无差异。在≥70 岁的患者中，与 200mg/m2 相比，140mg/m2 剂量的 Mel 与更差的结局相关，包括第 100 天的 NRM（1%[95%CI，1%-2%] vs 0%[95%CI，0%-1%]；P=0.003]）、2 年 PFS（64%[95%CI，60%-67%] vs 69%[95%CI，66%-73%]；P=0.003]）和 2 年 OS（85%[95%CI，82%-87%] vs 89%[95%CI，86%-91%]；P=0.01]），这可能与虚弱有关。
本研究结果表明，AHCT 仍然是所有年龄组 MM 患者的有效巩固治疗方法。
