Department of Hematology and BMT Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, India.
Department of Hematology and BMT Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi; Adult Hematolymphoid and BMT Unit, Tata Memorial Centre, ACTREC, Mumbai, Maharashtra, India (Present Affiliation); Homi Bhabha National Institute, Mumbai, Maharashtra, India (Present Afiliation).
Indian J Cancer. 2023 Jul-Sep;60(3):316-324. doi: 10.4103/ijc.IJC_272_21.
Multiple myeloma remains an incurable disease, with the majority of patients relapsing after autologous stem cell transplant (ASCT). After relapse, second transplant remains one of the therapeutic options, along with novel agents.
We reviewed the data of our patients who underwent ASCT for myeloma (N = 202) over the last two decades (2004-2019). Of these, 12 patients underwent a second transplant.
Out of 12 patients, nine underwent second autologous stem cell transplant, whereas three received an allogeneic stem cell transplantation (Allo-SCT). Median progression-free survival (PFS) after the first ASCT was 32 months (5-84 months). Median interval between both the transplants was 35 months (4-159 months). Median age of our cohort which underwent second transplant was 56 years. Overall response rate (ORR) post-second transplant on day +100 was 83.3%, without any transplant-related mortality (TRM). With the use of preemptive plerixafor, none of our patients required a second day for stem cell harvest. Median CD34 dose of stem cells infused was 4.11 × 10/kg. Similar to the first ASCT, the median time to neutrophil and platelet engraftment was 11 and 12 days, respectively. At a median follow-up of 41 months, estimated 3-year PFS and overall survival (OS) was 37% ± 15% and 63% ± 15%, respectively.
">Among all relapsed myeloma patients who were transplant eligible, 11% underwent a second transplant. Second transplant is well tolerated with similar time to engraftment after first ASCT. Hence, we believe that second transplant is a feasible, cost-effective option in a resource-limited setting, which should be more widely utilized.
多发性骨髓瘤仍然是一种无法治愈的疾病，大多数患者在自体干细胞移植（ASCT）后会复发。复发后，第二个移植仍然是治疗选择之一，同时还可以使用新型药物。
我们回顾了过去二十年（2004-2019 年）间接受 ASCT 治疗骨髓瘤的患者（N=202）的数据。其中，有 12 名患者接受了第二次移植。
在 12 名患者中，9 名接受了第二次自体干细胞移植，而 3 名接受了异基因干细胞移植（Allo-SCT）。第一次 ASCT 后无进展生存期（PFS）的中位数为 32 个月（5-84 个月）。两次移植之间的中位数间隔为 35 个月（4-159 个月）。接受第二次移植的患者队列的中位年龄为 56 岁。第二次移植后第 100 天的总体缓解率（ORR）为 83.3%，无移植相关死亡率（TRM）。使用预防性普乐沙福，我们的患者都不需要第二天进行干细胞采集。输注的干细胞中 CD34 剂量的中位数为 4.11×10/kg。与第一次 ASCT 相似，中性粒细胞和血小板植入的中位数时间分别为 11 天和 12 天。在中位数为 41 个月的随访中，估计 3 年的 PFS 和总生存率（OS）分别为 37%±15%和 63%±15%。
“在所有符合移植条件的复发骨髓瘤患者中，有 11%接受了第二次移植。第二次移植的耐受性良好，与第一次 ASCT 后植入的时间相似。因此，我们认为第二次移植是一种可行的、具有成本效益的选择，在资源有限的情况下应该得到更广泛的应用。”
