Swan Dawn, Hayden Patrick J, Eikema Dirk-Jan, Koster Linda, Sauer Sandra, Blaise Didier, Nicholson Emma, Rabin Neil, Touzeau Cyrille, Byrne Jennifer, Huynh Anne, Cornelissen Jan J, Potter Victoria, Forcade Edouard, Parrish Christopher, Gribben John, Chretien Marie-Lorraine, Mielke Stephan, Gedde-Dahl Tobias, Reményi Péter, Tsirigotis Panagiotis, Garcia Guiñón Antoni, Beksac Meral, Schönland Stefan, Yakoub-Agha Ibrahim
Department of Haematology, St James's Hospital, Dublin, Ireland.
European Society for Blood and Marrow Transplantation (EBMT) Statistical Unit, Leiden, the Netherlands.
Br J Haematol. 2022 Apr;197(1):82-96. doi: 10.1111/bjh.18025. Epub 2022 Feb 15.
Multiple myeloma (MM) accounts for 10% of haematological malignancies. Overall survival (OS) has improved in recent years due to increased use of autologous stem cell transplantation (ASCT) in the treatment of newly diagnosed MM and the advent of novel agents, including proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies. To assess trends in ASCT including patient selection, choice of induction regimen, depth of response and survival, we performed a retrospective analysis of all patients undergoing first ASCT for MM in European Society for Blood and Marrow Transplantation centres between 1995 and 2019. A total of 117 711 patients across 575 centres were included. The number of transplants performed increased sevenfold across the study period. The median age increased from 55 to 61 years, and the percentage of patients aged >65 years rose from 7% to 30%. Use of chemotherapy-based induction fell significantly, being largely replaced by bortezomib-based regimens. The two-year complete response rate increased from 22% to 42%. The five-year progression-free survival and OS rates increased from 28% to 31% and from 52% to 69%, respectively. Transplant mortality fell from 5.9% to 1.5%. Ongoing advances in MM treatment may challenge the future role of ASCT. However, at the current time, ASCT remains central to the MM treatment paradigm.
多发性骨髓瘤（MM）占血液系统恶性肿瘤的10%。近年来，由于在新诊断的MM治疗中自体干细胞移植（ASCT）的使用增加以及新型药物的出现，包括蛋白酶体抑制剂、免疫调节药物和单克隆抗体，总生存期（OS）有所改善。为了评估ASCT的趋势，包括患者选择、诱导方案的选择、缓解深度和生存率，我们对1995年至2019年期间在欧洲血液和骨髓移植中心接受首次MM-ASCT的所有患者进行了回顾性分析。共纳入了575个中心的117711例患者。在整个研究期间，进行移植的数量增加了7倍。中位年龄从55岁增加到61岁，年龄>65岁的患者百分比从7%上升到30%。基于化疗的诱导治疗的使用显著下降，主要被基于硼替佐米的方案所取代。两年完全缓解率从22%提高到42%。五年无进展生存率和OS率分别从28%提高到31%和从52%提高到69%。移植死亡率从5.9%降至1.5%。MM治疗的持续进展可能会挑战ASCT未来的作用。然而，目前ASCT仍然是MM治疗模式的核心。
