Association Between Autologous Stem Cell Transplant and Survival Among Californians With Multiple Myeloma
Association Between Autologous Stem Cell Transplant and Survival Among Californians With Multiple Myeloma
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DOI：
10.1093/jnci/djy073
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发表时间：
2019-01-01
影响因子：
10.3
通讯作者：
Wun, Ted
中科院分区：
文献类型：
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作者：
Rosenberg, Aaron S.;Brunson, Ann;Wun, Ted
背景：自体造血干细胞移植(AHSCT)是治疗初诊多发性骨髓瘤的有效方法。然而，随着快速发展带来了其他高效且强度较低的治疗方法，aHSCT的作用受到了质疑。方法我们利用基于人群的数据，在1998至2012年间确定了13494名年龄在80岁以下的新诊断患者。AHSCT组和非aHSCT组的患者特征通过预测aHSCT使用的倾向分数的逆概率加权来平衡。根据基线合并症、人口统计学和社会经济状况调整后的多变量模型估计了调整后的风险比(AHR)和死亡的95%可信区间(CI)。结果28.8%(2807)的患者接受了AHSCT，随着时间的推移，这一比例从1998-2002年的15.4%上升到2008-2012年的23.9%。在60岁以下和60~79岁的患者中，分别有37.6%和11.5%的患者使用了aHSCT。接受aHSCT的中位时间为9.4个月，89%的aHSCT发生在确诊后两年内。移植后中位总生存期为72.9个月(95%可信区间[CI]=68~78)。在任何时间进行自体HSCT均可提高存活率(AHR=0.83，95%CI=0.75~0.92)。在aHSCT受者中，移植后12个月以上(VS 12个月)的患者存活率较低(AHR=1.33，95%CI=1.16~1.51)。在不同研究时期和不同年龄组，aHSCT对总生存率的积极作用相似。结论在高效诱导治疗的时代，aHSCT仍然很少使用，但继续与多发性骨髓瘤患者的生存改善有关，应考虑用于新诊断的患者。
Background Autologous hematopoietic stem cell transplant (aHSCT) is an efficacious treatment for newly diagnosed multiple myeloma patients. However, as rapid advances have resulted in other highly efficacious and less intensive therapies, the role of aHSCT has been questioned.Methods We utilized population-based data to identify 13 494 newly diagnosed patients younger than age 80 years between 1998 and 2012. Patient characteristics of aHSCT and non-aHSCT groups were balanced using inverse probability weighting of a propensity score predicting aHSCT use. Multivariable models adjusted for baseline comorbidities, demographics, and socioeconomic status estimated the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of death.Results Twenty point eight percent (2807) of patients underwent aHSCT, and this rate increased over time from 15.4% in 1998-2002 to 23.9% in 2008-2012. aHSCT was utilized among 37.6% and 11.5% of patients younger than age 60 years and 60 to 79 years, respectively. The median time to aHSCT was 9.4 months, and 89% of all aHSCTs occurred within two years of diagnosis. The median overall survival from time of aHSCT was 72.9 months (95% confidence interval [CI] = 68 to 78). Autologous HSCT at any time was associated with improved survival (aHR = 0.83, 95% CI = 0.75 to 0.92). Among aHSCT recipients, transplant more than 12 months after diagnosis (vs 12 months) was associated with worse survival (aHR = 1.33, 95% CI = 1.16 to 1.51). The positive effect of aHSCT on overall survival was similar across study time periods and age groups.Conclusion In the era of highly efficacious induction therapies, aHSCT remained infrequently used but continued to be associated with improved survival for multiple myeloma patients and should be considered for newly diagnosed patients.