Influence of Pre- and Post-Transplantation Responses on Outcome of Patients With Multiple Myeloma: Sequential Improvement of Response and Achievement of Complete Response Are Associated With Longer Survival
Influence of Pre- and Post-Transplantation Responses on Outcome of Patients With Multiple Myeloma: Sequential Improvement of Response and Achievement of Complete Response Are Associated With Longer Survival
复制标题
DOI：
10.1200/jco.2008.17.9721
复制
发表时间：
2008-12-10
影响因子：
45.3
通讯作者：
San Miguel, Jesus F.
中科院分区：
文献类型：
--
作者：
Jose Lahuerta, Juan;Victoria Mateos, Maria;San Miguel, Jesus F.
完全缓解（CR）被认为是大多数恶性血液病治疗的重要目标。然而，在多发性骨髓瘤（MM）中，关于免疫固定（IF）阴性CR、IF阳性近CR（nCR）和部分缓解（PR）是否与不同的生存率相关，目前尚无共识。我们评估了在新诊断的MM患者中移植前和移植后这些反应对无事件生存期（EFS）和总生存期（OS）的预后影响。患者和方法我们分析了来自前瞻性Grupo Espanol de Mieloma 2000方案的632名患者，这些患者统一接受长春新碱、卡莫司汀、环磷酰胺、美法仑和泼尼松/长春新碱、卡莫司汀、阿霉素、和地塞米松诱导，然后高剂量治疗和自体干细胞transplantation.ResultsPost-transplantation反应显着影响的结果。与达到nCR的患者相比，达到CR的患者的EFS（中位数，61 vs 40个月; P < 10（-5））和OS（中位数未达到; P = 0.01）明显更长，与达到PR的患者相比，达到nCR的患者的结局也更好（中位数EFS，34个月，P = 0.07 vs nCR;中位数OS，61个月，P = 0.04）。老年（年龄65 - 70岁）和年轻（年龄< 65岁）患者的EFS和OS以及反应的影响相似。在移植前反应中观察到类似的结果，有EFS的趋势（P =. 1; P =. 05)达到CR与nCR和PR的患者的OS（P = 0.1; P = 0.07）分别获益。移植后反应显着影响移植前反应;反应的改善与延长survival.ConclusionQuality的反应移植后，特别是CR，显着相关EFS和OS延长在新诊断的MM患者。有类似的协会与移植前反应状态的趋势。
PurposeComplete response (CR) is considered an important goal in most hematologic malignancies. However, in multiple myeloma (MM), there is no consensus regarding whether immunofixation (IF)-negative CR, IF-positive near-CR (nCR), and partial response (PR) are associated with different survivals. We evaluated the prognostic influence on event-free survival (EFS) and overall survival (OS) of these responses pre- and post-transplantation in newly diagnosed patients with MM.Patients and MethodsWe analyzed 632 patients from the prospective Grupo Espanol de Mieloma 2000 protocol who were uniformly treated with vincristine, carmustine, cyclophosphamide, melphalan, and predisone/vincristine, carmustine, adryamcine, and dexamethasone induction followed by high-dose therapy and autologous stem-cell transplantation.ResultsPost-transplantation response markedly influenced outcomes. Patients achieving CR had significantly longer EFS (median, 61 v 40 months; P < 10(-5)) and OS (medians not reached; P = .01) versus patients achieving nCR, who likewise had somewhat better outcomes compared with patients achieving PR (median EFS, 34 months, P = .07 v nCR; median OS, 61 months, P = .04). EFS and OS and influence of response were similar among older (age 65 to 70 years) and younger (age < 65 years) patients. Similar findings were observed with pretransplantation response, with trends toward EFS (P =. 1; P =. 05) and OS (P = .1; P = .07) benefit in patients achieving CR versus nCR and PR, respectively. Post-transplantation response was markedly influenced by pretransplantation response; improvements in response were associated with prolonged survival.ConclusionQuality of response post-transplantation, notably CR, is significantly associated with EFS and OS prolongation in newly diagnosed patients with MM. There were trends toward similar associations with pretransplantation response status.