Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Clin Lymphoma Myeloma Leuk. 2021 Feb;21(2):80-90.e5. doi: 10.1016/j.clml.2020.08.021. Epub 2020 Sep 19.
Patients with multiple myeloma (MM) aged ≤ 65 to 70 years, with a good Eastern Cooperative Oncology Group performance status and no major comorbid conditions, are considered potential candidates for autologous stem cell transplant (ASCT) and will be treated with novel agent-based induction therapy for 4 to 6 cycles before ASCT.
We analyzed the data from 326 patients with MM who had received novel agent-based induction before ASCT at our center to evaluate the effect of induction therapy on ASCT response, stem cell mobilization, engraftment characteristics, and survival. The median age was 52 years (range, 29-72 years), 216 patients were men (66.3%), 32.7% had stage III using the Revised Multiple Myeloma International Staging System, and 15.8% had high-risk cytogenetics. Of the 326 patients, 75 (23.0%) had undergone ASCT in second remission after salvage therapy for relapse. Also, 194 patients (59.5%) had received doublet induction therapy and 132 (40.5%) had received triplet induction therapy.
Triplet-based induction therapy was superior to doublet-based therapy for response (95.4% vs. 84.02%; P < .003), stem cell mobilization (CD34 ≥ 2 × 10/kg; 88.6% vs. 76.8%; P < .005), and lower 100-day transplant-related mortality (P < .001). The ≥100 day post-ASCT overall response (97.4% vs. 91.7%; P = .124) and complete response (72.5% vs. 68.0%; P = .38) rates were similar. At a median follow-up of 62.5 months, the overall survival (97.5 months vs. 100.0 months; P = .606) and progression-free survival (54.5 months vs. 57 months; P = .515) were similar between the triplet and doublet induction groups.
An initial response (chemosensitivity) to induction therapy will prepare patients better for subsequent consolidation therapy and ASCT, leading to favorable outcomes.
年龄在 65 至 70 岁之间、东部合作肿瘤组（ECOG）体能状态良好且无重大合并症的多发性骨髓瘤（MM）患者被认为是自体干细胞移植（ASCT）的潜在候选者，他们将接受新型药物诱导治疗 4 至 6 个周期，然后再进行 ASCT。
我们分析了在我们中心接受新型药物诱导治疗后进行 ASCT 的 326 例 MM 患者的数据，以评估诱导治疗对 ASCT 反应、干细胞动员、植入特征和生存的影响。中位年龄为 52 岁（范围为 29-72 岁），216 例患者为男性（66.3%），32.7%的患者根据修订后的多发性骨髓瘤国际分期系统（R-ISS）分期为 III 期，15.8%的患者存在高危细胞遗传学异常。在 326 例患者中，75 例（23.0%）在挽救治疗后复发时接受了二线缓解后的 ASCT。此外，194 例（59.5%）接受了双药诱导治疗，132 例（40.5%）接受了三药诱导治疗。
三药诱导治疗在反应（95.4%比 84.02%；P<.003）、干细胞动员（CD34≥2×10/kg；88.6%比 76.8%；P<.005）和较低的 100 天移植相关死亡率（P<.001）方面优于双药诱导治疗。ASCT 后 100 天以上的总体反应率（97.4%比 91.7%；P=.124）和完全缓解率（72.5%比 68.0%；P=.38）相似。在中位随访 62.5 个月时，三药和双药诱导组的总生存率（97.5 个月比 100.0 个月；P=.606）和无进展生存率（54.5 个月比 57 个月；P=.515）相似。
诱导治疗的初始反应（化疗敏感性）将使患者更好地为随后的巩固治疗和 ASCT 做好准备，从而获得良好的结果。
