Tandem Autologous/Reduced-Intensity Conditioning Allogeneic Stem-Cell Transplantation Versus Autologous Transplantation in Myeloma: Long-Term Follow-Up
Tandem Autologous/Reduced-Intensity Conditioning Allogeneic Stem-Cell Transplantation Versus Autologous Transplantation in Myeloma: Long-Term Follow-Up
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DOI：
10.1200/jco.2010.32.7312
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发表时间：
2011-08-01
影响因子：
45.3
通讯作者：
Gahrton, Gosta
中科院分区：
文献类型：
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作者：
Bjorkstrand, Bo;Iacobelli, Simona;Gahrton, Gosta
目的异基因干细胞移植(Allo)治疗骨髓瘤的结果存在争议。在这项试验中，在未经治疗的多发性骨髓瘤患者中，比较了自体干细胞移植(AUTO)+低强度预适应配型同胞供者异基因移植(AUTO-ALLO)和单纯自体干细胞移植(AUTO)。有相合的同胞供体的患者被分配到自体异基因组(n=108)，没有匹配的同胞供体的患者被分配到自体组(n=249)。单人(n=145)或串联(n=104)AUTO是可选的。自体臂调理为马法兰200 mg/m(2)，异体臂调理为全身照射2Gy加氟达拉滨30 mg/m(2)/d，共3d。中位随访时间为61个月。结果自体移植组60个月的无进展存活率明显好于单纯移植组(35%比18%；P=.001)，长期死亡和复发的风险也较高(分别为P=0.047和P=0.003)。60个月的总存活率分别为65%和58%，复发率分别为49%和78%。完全缓解率分别为51%和41%(P=0.020)。自体移植后24个月的无复发死亡率为12%，而自体移植组为3%(P<；.001)。2~4级急性移植物抗宿主病(GvHD)的发生率为20%，局限性和广泛性慢性GvHD的发生率分别为31%和23%。结论在未经治疗的多发性骨髓瘤患者中，自体移植后的无进展生存期、总生存期和复发率均优于单纯自体移植。两组患者的无复发死亡率均处于合理水平。
PurposeResults of allogeneic stem-cell transplantation (allo) in myeloma are controversial. In this trial autologous stem-cell transplantation (auto) followed by reduced-intensity conditioning matched sibling donor allo (auto-allo) was compared with auto only in previously untreated multiple myeloma.Patients and MethodsIn all, 357 patients with myeloma up to age 69 years were enrolled from 2001 to 2005. Patients with an HLA-identical sibling donor were allocated to the auto-allo arm (n = 108) and patients without a matched sibling donor were allocated to the auto arm (n = 249). Single (n = 145) or tandem (n = 104) auto was optional. Conditioning for the auto arm was melphalan 200 mg/m(2); conditioning for the allo arm was total-body irradiation 2 Gy plus fludarabine 30 mg/m(2)/d for 3 days. Median follow-up time was 61 months. Primary end point was progression-free survival.ResultsProgression-free survival at 60 months was significantly better with auto-allo than with allo alone (35% v 18%; P = .001), as was the risk of death and of relapse in the long term (P = .047 and P = .003, respectively). Overall survival at 60 months was 65% versus 58%, and relapse incidence was 49% versus 78%. Complete remission rates were 51% and 41%, respectively (P = .020). Nonrelapse mortality at 24 months was 12% after auto-allo compared with 3% in the auto group (P < .001). The incidence of grade 2 to 4 acute graft-versus-host disease (GvHD) was 20%, and the incidence of limited and extensive chronic GvHD was 31% and 23%.ConclusionIn patients with previously untreated multiple myeloma, long-term outcome with respect to progression-free survival, overall survival, and relapse rate is superior after auto-allo compared with auto only. Nonrelapse mortality is at a reasonable level in both groups.