The impact of attaining a minimal disease state after high-dose melphalan and autologous transplantation for multiple myeloma
The impact of attaining a minimal disease state after high-dose melphalan and autologous transplantation for multiple myeloma
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DOI：
10.1046/j.1365-2141.2001.02530.x
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发表时间：
2001-03-01
影响因子：
6.5
通讯作者：
Morgan, GJ
中科院分区：
文献类型：
--
作者：
Davies, FE;Forsyth, PD;Morgan, GJ
骨髓瘤高剂量治疗（HDT）的初步研究表明，获得完全缓解（CR）具有一些有益作用;然而，由于研究之间缓解定义的不一致，难以评估对生存期的影响。我们分析了96例年龄小于65岁的新诊断患者接受HDT，并使用电泳，免疫固定和荧光IgH聚合酶链反应（PCR）来定义CR评估对生存率的影响。患者接受C-VAMP（阿霉素，长春新碱，甲基强的松龙，环磷酰胺）诱导化疗，随后接受美法仑200 mg/m2和外周血造血干细胞回输。对C-VAMP的反应很高[CR = 24%，部分反应（PR）= 64%]，除1例患者外，所有患者在HDT后的反应深度均有所改善（CR = 69%，PR = 31%）。中位无进展生存期（PFS）和总生存期（OS）为46.4个月和72+个月，无进展生存期（PFS）和总生存期（OS）极佳。与PR患者相比，免疫固定阴性CR患者的PFS有改善的趋势（49.4个月，41.14个月：P = 0.26），当使用电泳定义CR时，这一点并不明显。用于定义CR的方法对总生存率没有影响，荧光IgH PCR未能增加任何额外的预后信息。这项研究支持广泛使用欧洲骨髓移植组（EBMT）反应标准，并建议对电泳阴性的患者进行免疫固定。
Initial studies with high-dose therapy (HDT) in myeloma suggest some beneficial effects of attaining a complete response (CR); however, the effect on survival is difficult to assess owing to inconsistencies in the definition of response between studies. We have analysed 96 newly diagnosed patients aged less than 65 years who received HDT and assessed the effect of response on survival using electrophoresis, immunofixation and fluorescent IgH polymerase chain reaction (PCR) to define CR. Patients received induction chemotherapy with C-VAMP (adriamycin, vincristine, methylprednisolone, cyclophosphamide) followed by melphalan 200 mg/m(2) and reinfusion of peripheral brood stem cells. There was a high response to C-VAMP [CR = 24%, partial response (PR) = 64%], with all but one patient improving the depth of response after HDT (CR = 69%, PR = 31%). The progression-free survival (PFS) and overall survival (OS) were excellent at a median of 46.4 months and 72+ months, There was a trend towards an improved PFS in patients with an immunofixation-negative CR compared with patients with a PR (49.4 months, 41.14 months: P = 0.26), This was not evident when electrophoresis was used to define CR. The method used to define CR did not impact on the overall survival and fluorescent IgH PCR failed to add any additional prognostic information. This study supports the widespread use of the European Bone Marrow Transplantation group (EBMT) response criteria and suggests that immunofixation should be performed on an patients who become electrophoresis negative.