Relapse to prior autograft and chronic graft-versus-host disease are the strongest prognostic factors for outcome of melphalan/fludarabine-based dose-reduced allogeneic stem cell transplantation in patients with multiple myeloma
Relapse to prior autograft and chronic graft-versus-host disease are the strongest prognostic factors for outcome of melphalan/fludarabine-based dose-reduced allogeneic stem cell transplantation in patients with multiple myeloma
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DOI：
10.1016/j.bbmt.2004.06.002
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发表时间：
2004-10-01
影响因子：
4.3
通讯作者：
Zander, AR
中科院分区：
文献类型：
--
作者：
Kröger, N;Perez-Simon, JA;Zander, AR
我们评估了多发性骨髓瘤患者中基于美法仑/氟达拉滨的剂量减少的同种异体移植物的预后因素。从1998年至2002年，120例多发性骨髓瘤患者接受美法仑/氟达拉滨治疗，随后进行异基因干细胞移植。1年时治疗相关死亡率（TRM）的累积风险为18%（95%置信区间[CI]，12%-28%）。在多变量分析中，既往大剂量化疗后复发是TRM最重要的危险因素（风险比[HR]，2.80; 95% CI，1.16-6.74; P = .02），复发（HR，4.14; 95% CI，2.04-8.38; P < .001）、无事件生存期（HR，3.11; 95% CI，1.77-5.46; P < .001）和总生存期（HR，2.69; 95% CI，1.35-5.35; P = .005）。此外，在时间依赖性考克斯模型中，慢性移植物抗宿主病（GVHD）也显著减少了复发（HR，0.37; 95% CI，0.16-0.87; P = 0.02）。移植时，8%的患者完全缓解，而27%的患者病情进展。同种异体移植后，49%达到完全缓解，38%达到部分缓解。在移植时具有化疗敏感性且既往接受大剂量化疗后未复发的患者亚组中，接受外周血干细胞移植（n = 46），1年时TRM的累积风险仅为8%（95%CI，1%-54%）。对于相关供体（n = 34），2年估计无事件生存率和总生存率分别为60%（95% CI，42%-78%）和75%（95% CI，59%-91%），对于非相关供体（n = 12），分别为81%（95% CI，59%-100%）和92%（95% CI，76%-100%）。(C)2004年美国血液和骨髓移植学会。
We evaluated prognostic factors of melphalan/fludarabine-based dose-reduced allografts in patients with multiple myeloma. From 1998 to 2002, 120 patients with multiple myeloma were treated with melphalan/fludarabine followed by allogeneic stem cell transplantation. The cumulative risk at 1 year for treatment-related mortality (TRM) was 18% (95% confidence interval [CI], 12%-28%). In a multivariate analysis, relapse after prior high-dose chemotherapy was the most significant risk factor for TRM (hazard ratio [HR], 2.80; 95% CI, 1.16-6.74; P = .02), relapse (HR, 4.14; 95% CI, 2.04-8.38; P < .001), event-free survival (HR, 3.11; 95% CI, 1.77-5.46; P < .001), and overall survival (HR, 2.69; 95% CI, 1.35-5.35; P = .005). In addition, relapse was also significantly diminished by chronic graft-versus-host disease (GVHD) in a time-dependent Cox model (HR, 0.37; 95% CI, 0.16-0.87; P = .02). At transplantation, 8% of the patients were in complete remission, whereas 27% had progressive disease. After allografting, 49% achieved complete remission, and 38% achieved partial remission. In a subgroup of patients with chemosensitivity at transplantation and no relapse after prior high-dose chemotherapy who underwent transplantation with peripheral blood stem cells (n = 46), the cumulative risk of TRM at 1 year was only 8% (95% CI, 1%-54%). The 2-year estimated event-free and overall survival was 60% (95% CI, 42%-78%) and 75% (95% CI, 59%-91%), respectively, for related donors (n 34) and was 81% (95% CI, 59%-100%) and 92% (95% CI, 76%-100%), respectively, for unrelated donors (n = 12). (C) 2004 American Society for Blood and Marrow Transplantation.