Khan Sahar, Reece Donna, Atenafu Eshetu G, Bhella Sita, Chen Christine, Masih-Khan Esther, Paul Harminder, Prica Anca, Tiedemann Rodger, Trudel Suzanne, Kukreti Vishal
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Clin Lymphoma Myeloma Leuk. 2023 Feb;23(2):e97-e106. doi: 10.1016/j.clml.2022.11.007. Epub 2022 Nov 23.
Salvage transplant has been historically considered effective therapy for myeloma patients relapsing after first transplant, if they achieved adequate remission duration. However, the efficacy of novel agent combinations has called this paradigm into question.
We performed a retrospective analysis in a homogeneously treated cohort of 106 patients undergoing ASCT2 at our institution, all of whom received novel agent-based chemotherapy (immunomodulatory agent [IMiD] and/or proteasome inhibitor [PI]) for both induction and relapse. As an exploratory objective we assessed whether predictive thresholds of progression free survival post first transplant (ASCT1) for benefit post ASCT2 vary with use of IMiD maintenance post ASCT1.
The overall response rate (ORR) was 98% post-ASCT2 and treatment-related mortality (TRM) was low at 1.8%. With a median follow-up of 26 months (range 0.5-85) from ASCT2, median overall survival (OS) is estimated at 80 months (95% CI: ≥ 49-months) and median progression-free survival after ASCT2 (PFS2) at 24 months (95% CI 19-39). PFS post first transplant (PFS1) at >/= 50 months was associated with improved OS. Predictors of PFS2 included PFS1 ≤42 months and progression on IMiD-based maintenance post- ASCT1.
ASCT2 continues to offer acceptable outcomes for most patients treated within modern day treatment paradigms, with longer PFS after ASCT1 and IMiD non-refractory disease being associated with improved outcomes.
挽救性移植在历史上一直被认为是首次移植后复发的骨髓瘤患者的有效治疗方法，前提是他们获得了足够的缓解期。然而，新型药物组合的疗效对这一模式提出了质疑。
我们对在我院接受第二次自体干细胞移植（ASCT2）的106例患者进行了回顾性分析，所有患者在诱导和复发时均接受了基于新型药物的化疗（免疫调节剂[IMiD]和/或蛋白酶体抑制剂[PI]）。作为一个探索性目标，我们评估了首次移植（ASCT1）后无进展生存期的预测阈值对于ASCT2后获益的影响是否因ASCT1后使用IMiD维持治疗而有所不同。
ASCT2后的总缓解率（ORR）为98%，治疗相关死亡率（TRM）较低，为1.8%。自ASCT2起的中位随访时间为26个月（范围0.5 - 85个月），中位总生存期（OS）估计为80个月（95%置信区间：≥49个月），ASCT2后的中位无进展生存期（PFS2）为24个月（95%置信区间19 - 39）。首次移植后的无进展生存期（PFS1）> /= 50个月与总生存期改善相关。PFS2的预测因素包括PFS1≤42个月以及ASCT1后基于IMiD的维持治疗出现进展。
对于在现代治疗模式下接受治疗的大多数患者，ASCT2继续提供可接受的结果，ASCT1后无进展生存期延长以及IMiD非难治性疾病与更好的结果相关。
