Liam Christopher Chin Keong, Boo Yang Liang, Lee Yi Lin, Law Kian Boon, Ho Kim Wah, Shahnaz Syed Abdul Kadir Sharifah, Tan Jerome Tsen Chuen, Lau Ngee Siang, Ong Tee Chuan, Tan Sen Mui, Sathar Jameela
Department of Haematology, Ampang Hospital, Selangor, Malaysia.
Centre for Clinical Trial, Ampang Hospital, Selangor, Malaysia.
Blood Cell Ther. 2020 Dec 4;4(1):1-8. doi: 10.31547/bct-2020-009. eCollection 2021 Feb 25.
Multiple Myeloma (MM) is characterized by the presence of clonal plasma cells. These often result in complications including bone destruction, hypercalcemia, renal insufficiency, and anaemia. Induction with a triplet or quadruplet regimen followed by autologous stem cell transplantation (ASCT) has been the standard of care for transplant eligible patients to achieve durable remission.
This is a retrospective analytical study to determine the outcome of Multiple Myeloma patients who underwent ASCT in Ampang Hospital.
We included a 5-year cohort of patients transplanted from 1st July 2014 to 30th June 2019. Data were obtained through electronic medical records. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were analyzed using simple and multiple Cox proportional hazard regression analysis. All analyses were done using software R version 3.6.2 with validated statistical packages.
139 patients were analyzed. The median age at transplant was 56 years old and 56.1% are males (n＝78). The most common subtype is IgG Kappa (n＝67, 48.2%). Only 93 patients in which the International Staging System (ISS) could be determined, and among them, 33.3% of patients (n＝31) have advanced stage Ⅲ disease. The most common induction received before ASCT was a bortezomib based regimen and/or an immunomodulatory (IMiD) based regimen. 63.3% of patients achieved at least a very good partial response (VGPR) before ASCT. Most patients received myeloablative conditioning (MAC) (n＝119, 85.6%). The mean cell dose is 3.68×10/kg. The median time to engraftment was 11 days for both platelet and absolute neutrophil count (ANC). With the median follow-up of 17.3 (range, 6.2-33.4) months, the median OS and PFS were not reached. The 1-year and 2-year PFS were 75% (95% CI 66-82%) and 52% (95% CI 42-62%), respectively. The 1-year and 2-year OS were 82% (95% CI 74-88%) and 70% (95% CI 60-78%), respectively. 6 patients (4.3%) had transplant-related mortality (TRM). IgA subtype was found to adversely affect PFS. Maintenance therapy and the absence of renal impairment was associated with better PFS and OS.
Our study found that ASCT following induction treatment is safe and beneficial to achieve a deeper remission status. In our study, the addition of maintenance therapy is associated with an improved outcome in PFS and OS.
多发性骨髓瘤（MM）的特征是存在克隆性浆细胞。这些常常导致包括骨质破坏、高钙血症、肾功能不全和贫血等并发症。对于适合移植的患者，采用三联或四联方案诱导治疗后进行自体干细胞移植（ASCT）一直是实现持久缓解的标准治疗方法。
这是一项回顾性分析研究，旨在确定在安邦医院接受ASCT的多发性骨髓瘤患者的治疗结果。
我们纳入了2014年7月1日至2019年6月30日期间接受移植的5年队列患者。数据通过电子病历获得。使用简单和多重Cox比例风险回归分析来分析无进展生存期（PFS）和总生存期（OS）的预后因素。所有分析均使用具有经过验证的统计软件包的R 3.6.2版软件进行。
对139例患者进行了分析。移植时的中位年龄为56岁，男性占56.1%（n＝78）。最常见的亚型是IgG κ型（n＝67，48.2%）。仅93例患者可确定国际分期系统（ISS），其中33.3%的患者（n＝31）处于Ⅲ期晚期疾病。ASCT前最常用的诱导方案是以硼替佐米为基础的方案和/或基于免疫调节剂（IMiD）的方案。63.3%的患者在ASCT前至少达到了非常好的部分缓解（VGPR）。大多数患者接受了清髓性预处理（MAC）（n＝119，85.6%）。平均细胞剂量为3.68×10/kg。血小板和绝对中性粒细胞计数（ANC）的中位植入时间均为11天。中位随访时间为17.3（范围6.2 - 33.4）个月，OS和PFS的中位数未达到。1年和2年的PFS分别为75%（95%CI 66 - 82%）和52%（95%CI 42 - 62%）。1年和2年的OS分别为82%（95%CI 74 - 88%）和70%（95%CI 60 - 78%）。6例患者（4.3%）发生了移植相关死亡率（TRM）。发现IgA亚型对PFS有不利影响。维持治疗和无肾功能损害与更好的PFS和OS相关。
我们的研究发现，诱导治疗后进行ASCT对于实现更深的缓解状态是安全且有益的。在我们的研究中，添加维持治疗与PFS和OS的改善结果相关。
