Thurlapati Aswani, Wesson William, Davis James A, Gaffney Kelly J, Weeda Erin, Velayati Arash, Bakos Jonathan K, Granger Katelynn, Smith Deidra, Maldonado Andy P, Herrington Taylor, Potts Julia, Hashmi Hamza
Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA.
These authors contributed equally to the creation of the manuscript.
J Hematol. 2023 Dec;12(6):243-254. doi: 10.14740/jh1201. Epub 2023 Dec 9.
High-dose chemotherapy and autologous stem cell transplant (HDT-ASCT) has become a standard of care for transplant eligible newly diagnosed multiple myeloma (NDMM) patients. While cytogenetic abnormalities have been shown to affect outcomes after HDT-ASCT in clinical trials, these trials often exclude or underrepresent elderly patients with comorbidities and those belonging to ethnic minorities. We describe our institutional experience highlighting the impact of high-risk cytogenetic abnormalities (HRCAs) on outcomes after HDT-ASCT for NDMM patients.
A total of 449 patients with NDMM who underwent HDT-ASCT between February 2012 and August 2022 were included in this retrospective analysis. HRCAs included the presence of one or more of: deletion 17p, t(14;16), t(4;14), and amplification 1q. Survival analyses, including progression-free survival (PFS) and overall survival (OS), were performed using Kaplan-Meier estimator.
With a median follow-up of 29 (1 - 128) months for the entire patient population, the best overall response rate for the patients with HRCAs was lower compared to those with standard risk cytogenetics (90% vs. 96%; P = 0.01). Patients with HRCAs had an inferior PFS compared to patients with standard-risk cytogenetics (29 vs. 58 months; P < 0.001) without a difference in OS (70 months vs. not reached; P = 0.13).
In a multivariable analysis adjusting for factors including age, race, and comorbidities, HRCAs, non-lenalidomide-based maintenance, non-proteasome inhibitor-based maintenance, and age greater than 65 were associated with inferior PFS. Amongst these factors, only non-lenalidomide-based maintenance was associated with inferior OS.
大剂量化疗和自体干细胞移植（HDT-ASCT）已成为适合移植的新诊断多发性骨髓瘤（NDMM）患者的标准治疗方法。虽然在临床试验中细胞遗传学异常已被证明会影响HDT-ASCT后的治疗结果，但这些试验通常会排除或较少纳入患有合并症的老年患者以及少数族裔患者。我们描述了我们机构的经验，突出了高危细胞遗传学异常（HRCA）对NDMM患者HDT-ASCT后治疗结果的影响。
本回顾性分析纳入了2012年2月至2022年8月期间接受HDT-ASCT的449例NDMM患者。HRCA包括以下一种或多种情况的存在：17p缺失、t(14;16)、t(4;14)和1q扩增。使用Kaplan-Meier估计器进行生存分析，包括无进展生存期（PFS）和总生存期（OS）。
整个患者群体的中位随访时间为29（1 - 128）个月，与标准风险细胞遗传学患者相比，HRCA患者的最佳总体缓解率较低（90%对96%；P = 0.01）。与标准风险细胞遗传学患者相比，HRCA患者具有较差的PFS（29个月对58个月；P < 0.001），而OS无差异（70个月对未达到；P = 0.13）。
在对年龄、种族和合并症等因素进行调整的多变量分析中，HRCA、非来那度胺维持治疗、非蛋白酶体抑制剂维持治疗以及年龄大于65岁与较差的PFS相关。在这些因素中，只有非来那度胺维持治疗与较差的OS相关。
