Davis School of Medicine, Center for Hematology and Oncology Outcomes Research and Training (COHORT), University of California, Sacramento, CA, USA.
Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA.
Blood Cancer J. 2021 Jan 7;11(1):5. doi: 10.1038/s41408-020-00400-4.
Autologous stem cell transplant (aHSCT) is associated with improved survival for multiple myeloma (MM) patients but may be associated with second primary malignancy (SPM) development. Using the California Cancer Registry linked to statewide hospitalization data, we determined the cumulative incidence (CMI) of SPMs more than 1 year after MM diagnosis, accounting for the competing risk of death. AHSCT recipients were matched 1:2 to non-aHSCT patients. Adjusted hazard ratios (aHR) were estimated using the Fine and Gray method. Among 16,331 patients, 933 (5.7%) developed a SPM more than 1 year after diagnosis. The 10-year CMI of developing any SPM was 6.6%, 5.7% for solid tumor SPM and 0.9% for hematologic malignancies. The 10-year CMI of developing any SPM was similar among aHSCT [9.1% (7.7-10.7%)] and non-aHSCT [7.5% (6.5-8.6%)] (P = 0.26) recipients and there was no difference in solid-tumor SPMs (P = 0.98). The 10-year CMI of hematologic SPMs was higher among aHSCT recipients [2.1% (1.4-2.9%) vs. 0.8% (0.5-1.2%); P = 0.005], corresponding to a 1.3% absolute increase and an aHR of 1.51 (1.01-2.27). Ten-year myeloma-specific and non-cancer mortality rates were 59% (58.2-60.0%) and 18.1% (17.4-18.8%), respectively. Although aHSCT was associated with a small increase in hematologic SPMs, mortality was driven by MM and non-cancer causes.
自体干细胞移植（aHSCT）可提高多发性骨髓瘤（MM）患者的生存率，但可能与第二原发恶性肿瘤（SPM）的发生有关。本研究使用加利福尼亚癌症登记处与全州住院数据相关联，确定了 MM 诊断后 1 年以上 SPM 的累积发生率（CMI），同时考虑了死亡的竞争风险。将 aHSCT 受者与非 aHSCT 患者进行 1:2 匹配。使用 Fine 和 Gray 方法估计调整后的风险比（aHR）。在 16331 名患者中，有 933 名（5.7%）在诊断后 1 年以上发生了 SPM。发生任何 SPM 的 10 年 CMI 为 6.6%，实体瘤 SPM 为 5.7%，血液恶性肿瘤为 0.9%。aHSCT [9.1%（7.7-10.7%）]和非 aHSCT [7.5%（6.5-8.6%）]患者发生任何 SPM 的 10 年 CMI 相似（P=0.26），实体瘤 SPM 也无差异（P=0.98）。aHSCT 受者血液恶性肿瘤的 10 年 CMI 较高[2.1%（1.4-2.9%）比 0.8%（0.5-1.2%）；P=0.005]，绝对增加 1.3%，aHR 为 1.51（1.01-2.27）。10 年多发性骨髓瘤特异性和非癌症死亡率分别为 59%（58.2-60.0%）和 18.1%（17.4-18.8%）。尽管 aHSCT 与血液学 SPM 略有增加相关，但死亡率由 MM 和非癌症原因驱动。
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