Polyclonal Immunoglobulin Recovery after Autologous Stem Cell Transplantation Is an Independent Prognostic Factor for Survival Outcome in Patients with Multiple Myeloma
Polyclonal Immunoglobulin Recovery after Autologous Stem Cell Transplantation Is an Independent Prognostic Factor for Survival Outcome in Patients with Multiple Myeloma
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DOI：
10.3390/cancers12010012
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发表时间：
2020-01-01
期刊：
影响因子：
5.2
通讯作者：
Abe, Masahiro
中科院分区：
文献类型：
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作者：
Ozaki, Shuji;Harada, Takeshi;Abe, Masahiro
我们回顾分析了接受自体干细胞移植(ASCT)但未接受维持治疗的多发性骨髓瘤(MM)患者，以评估正常免疫球蛋白(Ig)恢复对临床结果的影响。多克隆免疫球蛋白的恢复定义为ASCT后1年血清免疫球蛋白、免疫球蛋白A和免疫球蛋白M全部恢复正常。50例ASCT患者中，26例多克隆Ig恢复，14例完全缓解(CR)，12例未完全缓解。与未恢复免疫球蛋白的患者相比，免疫球蛋白恢复的患者的无进展生存期(PFS，中位数为46.8vs.26.7个月，p=0.0071)和总体生存期(OS，中位数，未达65.3月，p<；0.00001)明显更好。免疫球蛋白恢复的生存益处在-gt；=CR患者(中位OS，未达到80.5个月，p=0.061)和非CR患者(中位OS，未达到53.2个月，p=0.00016)中观察到类似。多因素分析显示，未完全缓解和免疫球蛋白未全部恢复是预测PFS的独立预后因素(HR，4.284，95%CI(1.868~9.826)，p=0.00059；HR，2.804，95%CI(1.334~5.896)，p=0.0065)；OS(HR，8.245，95%CI(1.528~44.47)，p=0.014；HR，36.55，95%CI(3.942~338.8)，p=0.0015)。因此，除了反应的深度外，ASCT后多克隆Ig的恢复是一个有用的指标，特别是对长期结果，可以被认为是预防移植MM患者使用维持治疗的过度治疗。
We retrospectively analyzed multiple myeloma (MM) patients who underwent autologous stem cell transplantation (ASCT) without maintenance therapy to assess the impact of recovery of normal immunoglobulin (Ig) on clinical outcomes. The recovery of polyclonal Ig was defined as normalization of all values of serum IgG, IgA, and IgM 1 year after ASCT. Among 50 patients, 26 patients showed polyclonal Ig recovery; 14 patients were in >= complete response (CR) and 12 remained in non-CR after ASCT. The patients with Ig recovery exhibited a significantly better progression-free survival (PFS, median, 46.8 vs. 26.7 months, p = 0.0071) and overall survival (OS, median, not reached vs. 65.3 months, p < 0.00001) compared with those without Ig recovery. The survival benefits of Ig recovery were similarly observed in >= CR patients (median OS, not reached vs. 80.5 months, p = 0.061) and non-CR patients (median OS, not reached vs. 53.2 months, p = 0.00016). Multivariate analysis revealed that non-CR and not all Ig recovery were independent prognostic factors for PFS (HR, 4.284, 95%CI (1.868-9.826), p = 0.00059; and HR, 2.804, 95%CI (1.334-5.896), p = 0.0065, respectively) and also for OS (HR, 8.245, 95%CI (1.528-44.47), p = 0.014; and HR, 36.55, 95%CI (3.942-338.8), p = 0.0015, respectively). Therefore, in addition to the depth of response, the recovery of polyclonal Ig after ASCT is a useful indicator especially for long-term outcome and might be considered to prevent overtreatment with maintenance therapy in transplanted patients with MM.