LDH and renal function are prognostic factors for long-term outcomes of multiple myeloma patients undergoing allogeneic hematopoietic stem cell
LDH and renal function are prognostic factors for long-term outcomes of multiple myeloma patients undergoing allogeneic hematopoietic stem cell
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DOI：
10.1038/s41409-020-0829-1
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发表时间：
2020-02-17
影响因子：
4.8
通讯作者：
Shimoni, Avichai
中科院分区：
文献类型：
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作者：
Shouval, Roni;Teper, Omer;Shimoni, Avichai
异基因造血干细胞移植（allo-SCT）可能为选定的多发性骨髓瘤（MM）患者提供治愈。有效的预后指标，以指导患者的选择是必要的。我们回顾性研究了100例接受allo-SCT的复发性难治性MM患者。中位随访时间为12.2年，中位总生存期（OS）和无进展生存期（LFS）分别为9.2个月和5.6个月。5-年OS和PFS分别为18.0%和16.8%。5年累积复发率为45.9%，非复发死亡率（NRM）为36.0%。在多变量考克斯模型中，白蛋白降低、乳酸脱氢酶（LDH）升高、晚期疾病和不匹配供体可预测OS和PFS降低。LDH低于正常值上限的患者的5年OS概率高于正常值上限的患者（22% vs. 5%，p = 0.004）。在多变量分析中，NRM的风险随着低白蛋白、不匹配供体类型和估计肾小球滤过率（eGFR）下降而增加。eGFR较低的患者5年NRM发生率为31%，而eGFR较高的患者为56%（p = 0.02）。移植物抗宿主病与预后改善无关。总之，LDH、肾功能和白蛋白是接受allo-SCT治疗的MM患者结局的重要信息。
Allogeneic hematopoietic stem cell transplantation (allo-SCT) may offer a cure for selected patients with multiple myeloma (MM). Effective prognostic markers to guide patient selection are warranted. We retrospectively studied a cohort of 100 relapsed refractory MM patients who underwent allo-SCT. With a median follow-up of 12.2 years, median overall survival (OS) and progression-free survival (LFS) were 9.2 months and 5.6 months, respectively. 5-years OS and PFS were was 18.0% and 16.8%. The cumulative incidence of 5-years relapse was 45.9% and non-relapse mortality (NRM) 36.0%. In a multivariable Cox model, decreasing albumin, increasing lactate dehydrogenase (LDH), advanced disease, and mismatched donors were predictive of both reduced OS and PFS. The probability of 5-years OS was higher in patients with LDH below vs. the upper limit of normal (22% vs. 5%, p = 0.004). In the multivariable analysis, the hazard of NRM was increased with low albumin, mismatched donor type, and declining estimated glomerular filtration rate (eGFR). Patients with a low eGFR had a 5-year NRM incidence of 31% vs. 56% in patients with higher levels (p = 0.02). Graft-versus-host disease was not associated with improved outcomes. In conclusion, LDH, renal function, and albumin are highly informative of outcomes in MM patients treated with allo-SCT.