PROGNOSTIC FACTORS IN ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR MULTIPLE-MYELOMA
PROGNOSTIC FACTORS IN ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR MULTIPLE-MYELOMA
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DOI：
10.1200/jco.1995.13.6.1312
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发表时间：
1995-06-01
影响因子：
45.3
通讯作者：
VOLIN, L
中科院分区：
文献类型：
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作者：
GAHRTON, G;TURA, S;VOLIN, L
目的：分析异基因骨髓移植治疗多发性骨髓瘤的预后因素。患者和方法：对1983年至1993年初欧洲血液和骨髓移植组织登记的162例多发性骨髓瘤同胞相合骨髓移植的预后因素进行分析。终点为完全缓解、存活率和完全缓解持续时间。结果：接受骨髓移植后，44%的患者和60%的可评估患者进入完全缓解。4年和7年的总体精算生存率分别为32%和28%。72例骨髓移植后完全缓解的患者6年无复发生存率为34%。影响移植前存活的有利预后因素包括女性(4岁时占41%)、确诊时I期疾病(4岁时占52%)、既往治疗一次(4年时占42%)、条件调整前处于完全缓解状态(3年时占%)。免疫球蛋白A亚型骨髓瘤和低β(2)-微球蛋白水平(-lt；4g/L)也倾向于对预后有有利影响。移植后最重要的预后因素是进入完全缓解状态。移植物抗宿主病(GVHD)分级为III~IV级的患者存活率较低。结论：骨髓移植前对治疗有反应并在一线治疗后进行移植的肿瘤负担较低的患者在骨髓移植后预后最好。(C)1995年，由美国临床肿瘤学会主办。
Purpose: To analyze prognostic factors for allogeneic bone marrow transplantation (BMT) in multiple myeloma.Patients and Methods: One hundred sixty-two reports of allogeneic matched sibling-donor transplants in multiple myeloma received by the European Group for Blood and Marrow Transplantation (EBMT) registry between 1983 and early 1993 were analyzed for prognostic factors. End points were complete remission, survival, and duration of complete remission.Results: Following BMT, 44% of all patients and 60% of assessable patients entered complete remission. The overall actuarial survival rate was 32% at 4 years and 28% at 7 years. The overall relapse-free survival rate of 72 patients who were in complete remission after BMT was 34% at 6 years. Favorable pretransplant prognostic factors for survival were female sex (41% at 4 years), stage I disease at diagnosis (52% at 4 years), one line of previous treatment (42% at 4 years), and being in complete remission before conditioning (64% at 3 years). The subtype immunoglobulin A (IgA) myeloma and a low beta(2)-microglobulin lever (< 4 g/L) also tended to have a favorable prognostic impact. The most important posttransplant prognostic factor was to enter a complete remission. Grade III to IV graft-versus-host disease (GVHD) was associated with poor survival.Conclusion: Patients with a low tumor burden who respond to treatment before BMT and are transplanted after first-line therapy have the best prognosis following BMT. (C) 1995 by American Society of Clinical Oncology.