Ludwig Heinz, Bernhard Sarah, Ikeda Takashi, Freytes Cesar O, Schreder Martin, Kawamura Koji, Atsuta Yoshiko, Takamatsu Hiroyuki, Vesole David H, Hari Parameswaran, Krainer Julie, Hinke Axel
Wilhelminen Cancer Research Institute, Vienna, Austria.
Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan.
Cancer. 2025 May 15;131(10):e35896. doi: 10.1002/cncr.35896.
Allogeneic stem cell transplantation (allo-SCT) has curative potential and was previously considered by several experts superior to autologous stem cell transplantation (auto-SCT) for patients with multiple myeloma relapsing after first-line auto-SCT.
The authors conducted a comprehensive literature review of English-language studies published from 1995 to October 2024. Five studies comparing allo-SCT with second auto-SCT following first line auto-SCT in multiple myeloma were included. Two additional studies comparing patients with or without a suitable allo-SCT donor after relapse were analyzed separately. Individual data from 815 patients were obtained from two large databases: the Japan Society for Hematopoietic Stem Cell Transplantation and the Center for International Blood & Marrow Transplant Research (CIBMTR). Data from five smaller studies (three comparing allo-vs. auto-SCT and two comparing donor vs. no-donor groups) presented via Kaplan-Meier curves were digitized using the Shiny app. Meta-analyses were performed using R 4.3.3. Kaplan-Meier and log-rank tests for overall survival (OS) and progression-free survival (PFS) were conducted in SPSS.
Individual patient data analysis showed significantly longer OS in the auto-SCT group. This benefit was consistent in the three smaller studies. PFS was also superior for auto-SCT in the CIBMTR data set and the pooled smaller studies. In the two-donor vs. no-donor studies, the donor group showed better PFS, with OS also improved when data were combined.
Allo-SCT after relapse from first line auto-SCT resulted in inferior OS and PFS compared to a second auto-SCT. These findings indicate that allo-SCT should no longer be recommended in patients with multiple myeloma relapsing after first line auto-SCT.
异基因干细胞移植（allo-SCT）具有治愈潜力，此前一些专家认为，对于一线自体干细胞移植（auto-SCT）后复发的多发性骨髓瘤患者，异基因干细胞移植优于自体干细胞移植。
作者对1995年至2024年10月发表的英文研究进行了全面的文献综述。纳入了五项比较allo-SCT与一线auto-SCT后二次自体干细胞移植治疗多发性骨髓瘤的研究。另外两项比较复发后有或没有合适allo-SCT供体的患者的研究分别进行了分析。来自815名患者的个体数据取自两个大型数据库：日本造血干细胞移植学会和国际血液与骨髓移植研究中心（CIBMTR）。通过Kaplan-Meier曲线呈现的五项较小研究（三项比较allo-SCT与auto-SCT，两项比较有供体组与无供体组）的数据使用Shiny应用程序进行数字化处理。使用R 4.3.3进行荟萃分析。在SPSS中进行Kaplan-Meier分析以及总生存期（OS）和无进展生存期（PFS）的对数秩检验。
个体患者数据分析显示auto-SCT组的总生存期明显更长。这一益处在三项较小的研究中是一致的。在CIBMTR数据集和汇总的较小研究中，auto-SCT的无进展生存期也更优。在两项有供体与无供体的研究中，有供体组显示出更好的无进展生存期，合并数据时总生存期也有所改善。
一线auto-SCT复发后进行allo-SCT，与二次auto-SCT相比，总生存期和无进展生存期较差。这些发现表明，对于一线auto-SCT后复发的多发性骨髓瘤患者，不应再推荐allo-SCT。
