Salvage autologous stem cell transplantation for multiple myeloma relapsing or progressing after up-front autologous transplantation
Salvage autologous stem cell transplantation for multiple myeloma relapsing or progressing after up-front autologous transplantation
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DOI：
10.3109/10428194.2013.773998
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发表时间：
2013-10-01
影响因子：
2.6
通讯作者：
Rahemtulla, Amin
中科院分区：
文献类型：
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作者：
Auner, Holger W.;Szydlo, Richard;Rahemtulla, Amin
绝大多数接受预先自体造血细胞移植（AHCT1）的多发性骨髓瘤（MM）患者会发生进展或复发，这仍然是新药物时代治疗的基石。对于AHCT1后复发/进展的患者，第二次AHCT （AHCT2）抢救治疗的价值数据有限。我们分析了1994年至2011年间83例接受补救性AHCT2的患者的结果。大多数患者（77%）在AHCT1和AHCT2之间接受了新型药物治疗，28%的患者来自少数民族。AHCT2的中位总生存期（OS）为31.5个月（95%可信区间[CI]: 22-41），中位无进展生存期（PFS）为15.5个月（95% CI: 11-20）。在多变量分析中，只有AHCT2的疾病状态（>= PR）与更好的OS相关。>PR和PR患者接受AHCT2治疗的3年OS率分别为85.9% （95% CI: 61-96）和51.3% （95% CI: 34-68）。在多变量分析中，AHCT2时的疾病状态和AHCT1后的进展/复发时间与PFS相关。总之，补救性AHCT2是化疗敏感性复发/进展和既往自体移植物后缓解期延长的患者的有效治疗选择。
Progression or relapse occurs in the vast majority of patients with multiple myeloma (MM) who undergo up-front autologous hematopoietic cell transplantation (AHCT1), which remains a cornerstone of treatment in the era of novel agents. Limited data are available regarding the value of salvage therapy with a second AHCT (AHCT2) in patients who relapse/progress after AHCT1. We analyzed the outcome of 83 patients who underwent salvage AHCT2 between 1994 and 2011. Most patients (77%) had received treatment with novel agents between AHCT1 and AHCT2, and 28% of patients were from ethnic minority groups. Median overall survival (OS) from AHCT2 was 31.5 months (95% confidence interval [CI]: 22-41), and median progression-free survival (PFS) was 15.5 months (95% CI: 11-20). In multivariate analysis, only disease status (>= PR) at AHCT2 was associated with better OS. The 3-year OS rates for patients receiving AHCT2 in >PR and PR were 85.9% (95% CI: 61-96) and 51.3% (95% CI: 34-68), respectively. Disease status at AHCT2 and time to progression/relapse after AHCT1 were associated with PFS in multivariate analysis. In summary, salvage AHCT2 is an effective treatment option in patients with chemosensitive relapse/progression and prolonged remission after a prior autograft.