Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation
Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation
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DOI：
10.1016/j.bbmt.2019.07.004
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发表时间：
2019-11-01
影响因子：
4.3
通讯作者：
Kroeger, Nicolaus
中科院分区：
文献类型：
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作者：
Gagelmann, Nico;Eikema, Diderik-Jan;Kroeger, Nicolaus
尽管大剂量治疗和自体干细胞移植结合新型药物仍然是新诊断的符合移植条件的多发性骨髓瘤患者一线治疗的标志，但串联自体或自体/低强度同种异体移植对髓外疾病(EMD)和高危细胞遗传学患者的影响尚未确定。在这里，我们分析了2003年至2015年间488名患有EMD的成人骨髓瘤患者的临床和细胞遗传学数据，这些患者接受了单一自体(n=373)、串联自体(n=84)或自体-异体移植(n=31)。41%(n=202)出现至少1个高危异常，其中del(17p)(40%)和t(4；14)(45%)最常见。54%的患者出现1个以上高危异常。高危细胞遗传学的四年总生存率(OS)和无进展生存率(PFS)分别为54%和29%，低于标准风险细胞遗传学的78%和49%(P<；.001)。高危异常的共同隔离似乎不会影响结果。在移植方案方面，单一自体移植的OS和PFS分别为70%和43%，而串联自体移植的OS和PFS分别为83%和52%，自体异体移植的OS和PFS分别为88%和58%(P=0.06和P=.30)。在多变量分析中，高危细胞遗传学与较差的存活率相关(风险比[HR]，2.00；P=.003)，而串联自体移植较单一自体移植显著改善预后(NRS，.46和.64；P=.02和P=.03)。自体同种异体移植在结果上没有显著差异，但似乎提高了存活率，但由于人口较少，结果有限(HR，.31)。综上所述，高危细胞遗传学常见于新诊断的骨髓瘤合并EMD，并且在单次自体移植后预后显著恶化，而串联自体移植策略可能克服发病时预后不良的问题。(C)2019年美国移植和细胞治疗学会。由爱思唯尔公司出版。
Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologous-allogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous-allogeneic (P=.06 and P =.30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR.], 2.00; P = .003), whereas tandem autologous significantly improved outcome versus single autologous transplant (NRs,.46 and.64; P = .02 and P = .03). Autologous allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, .31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.