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. 2022 Sep;22(9):e826-e835. doi: 10.1016/j.clml.2022.04.020. Epub 2022 Apr 25.
Autologous stem cell transplant (ASCT) is a standard therapy for transplant eligible patients of multiple myeloma (MM). To evaluate impact of time to transplant on subsequent outcomes, we analyzed data on consecutive MM patients who received novel agents-based induction prior to transplant.
Between 2006 and 2019, 363 MM patients underwent ASCT. Patients' median age was 52 years, ranging from 20 to 72 years, 233 (64.2%) were males. Median interval from diagnosis to transplant was 11.5 months (range, 4-67.5); 201 (55.4%) patients underwent ASCT within 12 months (early) and 162 (44.6%) beyond 12 months since diagnosis (delayed ASCT). Primary objective was progression-free survival. Secondary objectives were-response rate to transplant, overall survival (OS), and transplant-related mortality (TRM).
Post-ASCT complete response (CR) (77.1% vs. 64.8%; P < .025) and CR+ very good partial response rate (89% vs. 81.5%; P < .03) was higher for early ASCT cohort. Engraftment characteristics, regimen-related toxicities, and day +100 TRM (3.5% vs 3.7%; P = .564) were similar in 2 cohorts. Median OS for early versus late cohort from date of diagnosis is 127.0 (95% CI, 98.9-155.1) versus 104.5 months (95% CI, 79.3-129.6; P = .356) and from date of transplant is 119.0 (95% CI, 93.4-144.6) versus 89.5 months (95% CI, 57.4-121.6), P < .02. Median PFS is better for early transplant cohort; 69.5 (95% CI, 56.7-82.3) versus 50.0 months (95% CI, 35.6-64.4), P < .05, respectively.
Early transplant for myeloma is associated with higher response rate and better progression-free survival.
自体干细胞移植（ASCT）是适合移植的多发性骨髓瘤（MM）患者的标准治疗方法。为了评估移植时间对后续结果的影响，我们分析了在移植前接受新型药物诱导治疗的连续 MM 患者的数据。
2006 年至 2019 年间，363 例 MM 患者接受了 ASCT。患者的中位年龄为 52 岁，范围为 20-72 岁，233 例（64.2%）为男性。诊断至移植的中位间隔为 11.5 个月（范围为 4-67.5）；201 例（55.4%）患者在 12 个月内（早期）接受 ASCT，162 例（44.6%）超过诊断后 12 个月（延迟 ASCT）。主要目标是无进展生存期。次要目标是移植后的缓解率、总生存期（OS）和移植相关死亡率（TRM）。
早期 ASCT 队列的移植后完全缓解（CR）（77.1% vs. 64.8%；P <.025）和 CR+非常好的部分缓解率（89% vs. 81.5%；P <.03）更高。2 个队列的嵌合特征、方案相关毒性和第 100 天的 TRM（3.5% vs. 3.7%；P = .564）相似。早期和晚期队列从诊断日期的中位 OS 分别为 127.0（95%CI，98.9-155.1）和 104.5 个月（95%CI，79.3-129.6；P = .356），从移植日期的中位 OS 分别为 119.0（95%CI，93.4-144.6）和 89.5 个月（95%CI，57.4-121.6），P <.02。早期移植队列的中位 PFS 更好；69.5（95%CI，56.7-82.3）与 50.0 个月（95%CI，35.6-64.4），P <.05。
多发性骨髓瘤的早期移植与更高的缓解率和更好的无进展生存期相关。
