Suppr超能文献

接受早期自体造血干细胞移植的标准风险多发性骨髓瘤患者的预后

Outcomes of Standard-Risk Multiple Myeloma Patients Who Undergo Upfront Autologous Hematopoietic Stem Cell Transplantation.

作者信息

Pasvolsky Oren, Marcoux Curtis, Wang Zhongya, Milton Denái R, Pal Babar, Tanner Mark R, Bashir Qaiser, Srour Samer, Saini Neeraj, Lin Paul, Ramdial Jeremy, Nieto Yago, Tang Guilin, Syed Naureen, Aljawai Yosra, Lee Hans C, Patel Krina K, Becnel Melody R, Ye Christine, Kebriaei Partow, Thomas Sheeba K, Orlowski Robert Z, Champlin Richard E, Shpall Elizabeth J, Qazilbash Muzaffar H

机构信息

Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Division of Hematology, Dalhousie University, Halifax, Canada.

出版信息

Transplant Cell Ther. 2025 Mar;31(3):166.e1-166.e9. doi: 10.1016/j.jtct.2024.12.023. Epub 2024 Dec 31.

Abstract

Patients with multiple myeloma (MM) without high-risk cytogenetic abnormalities are classified as having standard-risk MM (SRMM), and data focusing on their outcomes after autologous hematopoietic stem cell transplantation (autoHCT) are limited. We sought to evaluate survival outcomes for patients with SRMM receiving autoHCT, and to elucidate factors that impact these outcomes. This was a single-center retrospective analysis that included consecutive MM patients who received upfront autoHCT between 2013 and 2021, had available cytogenetic information and had no high-risk chromosomal abnormalities on fluorescence in situ hybridization, defined as t(4;14), t(14;16), del(17p) or 1q21 gain or amplification. A total of 1000 SRMM patients were included, with a median age of 61 years (range 25 to 83), and 61% were male (n = 612). The most common induction regimens were bortezomib/lenalidomide/dexamethasone (VRD; n = 398, 40%) and carfilzomib/lenalidomide/dexamethasone (KRD; n = 212, 21%), and the majority (87%) received single-agent melphalan as conditioning. After induction and before autoHCT, 16% and 57% achieved ≥complete response (CR) and ≥very good partial response (VGPR), respectively. At day 100 post autoHCT, 37% and 77% achieved ≥CR and ≥VGPR, respectively. Sixty-two percent and 89% of patients achieved ≥ CR and ≥VGPR as best response post-transplant. A minimal residual disease (MRD) negative response pre- and post-transplantation was achieved in 43% (401/936) and 64% (199/311) of patients, respectively. After a median follow-up of 42.1 months, the median progression-free survival (PFS) for the entire cohort was 68.3 months (95% CI 60.1 to 72.1), and the median overall survival (OS) was not reached (95% CI 102.3-not reached). The 5-year PFS and OS rates were 55% and 83%, respectively. In multivariable analysis, achieving MRD-negative CR prior to autoHCT (HR 0.65 [95% CI 0.44 to 0.97], P = .033) or as best response (0.52 [0.34 to 0.78], P = .002), and use of post-transplant maintenance (0.69 [0.52 to 0.93], P = .013) and lenalidomide-based combination maintenance (0.68 [0.48 to 0.96], P = .030) were associated with improved PFS, whereas use of an induction regimen other than KRD was associated with worse PFS (1.50 [1.04 to 2.17], P = .031). For OS, post-transplant maintenance (0.48 [0.32 to 0.70], P < .001) was associated with better survival in multivariable analysis, whereas R-ISS stage III, compared with stage I, (2.34 [1.01 to 5.43], P = .047) was associated with worse OS. Patients with SRMM who received upfront autoHCT had a median PFS of >5.5 years, and median OS was not reached. These results highlight the favorable outcomes with upfront autoHCT for patients with SRMM, serving as a benchmark for future therapeutic approaches in this subgroup of MM patients.

摘要

无高危细胞遗传学异常的多发性骨髓瘤(MM)患者被归类为标准风险MM(SRMM),而关注其自体造血干细胞移植(autoHCT)后结局的数据有限。我们旨在评估接受autoHCT的SRMM患者的生存结局,并阐明影响这些结局的因素。这是一项单中心回顾性分析,纳入了2013年至2021年间接受一线autoHCT、有可用细胞遗传学信息且荧光原位杂交未发现高危染色体异常(定义为t(4;14)、t(14;16)、del(17p)或1q21扩增)的连续MM患者。共纳入1000例SRMM患者,中位年龄61岁(范围25至83岁),61%为男性(n = 612)。最常见的诱导方案是硼替佐米/来那度胺/地塞米松(VRD;n = 398,40%)和卡非佐米/来那度胺/地塞米松(KRD;n = 212,21%),大多数患者(87%)接受单药美法仑作为预处理。诱导后及autoHCT前,分别有16%和57%的患者达到≥完全缓解(CR)和≥非常好的部分缓解(VGPR)。autoHCT后第100天,分别有37%和77%的患者达到≥CR和≥VGPR。62%和89%的患者移植后最佳缓解为≥CR和≥VGPR。移植前和移植后分别有43%(401/936)和64%(199/311)的患者达到微小残留病(MRD)阴性反应。中位随访42.1个月后,整个队列的中位无进展生存期(PFS)为68.3个月(95%CI 60.1至72.1),中位总生存期(OS)未达到(95%CI 102.3 - 未达到)。5年PFS率和OS率分别为55%和83%。多变量分析中,请在autoHCT前达到MRD阴性CR(HR 0.65 [95%CI 0.44至0.97],P = 0.033)或作为最佳缓解(0.52 [0.34至0.78],P = 0.002),以及使用移植后维持治疗(0.69 [0.52至0.93],P = 0.013)和基于来那度胺的联合维持治疗(0.68 [0.48至0.96],P = 0.030)与PFS改善相关,而使用KRD以外的诱导方案与较差的PFS相关(1.50 [1.04至2.17],P = 0.031)。对于OS,多变量分析中移植后维持治疗(0.48 [0.32至0.70],P < 0.001)与更好的生存相关,而与I期相比,R-ISS III期(2.34 [1.01至5.43],P = 0.047)与较差的OS相关。接受一线autoHCT的SRMM患者中位PFS>5.5年,中位OS未达到。这些结果突出了一线autoHCT对SRMM患者的良好结局,为该MM患者亚组未来的治疗方法提供了基准。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验