Significance of maintenance therapy after HDT/ASCT in symptomatic multiple myeloma: A multicenter retrospective analysis in Kansai Myeloma Forum.
Significance of maintenance therapy after HDT/ASCT in symptomatic multiple myeloma: A multicenter retrospective analysis in Kansai Myeloma Forum.
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DOI：
10.1002/jha2.284
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发表时间：
2021-11
期刊：
影响因子：
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通讯作者：
Nomura, Shosaku
中科院分区：
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作者：
Nakaya, Aya;Shibayama, Hirohiko;Nakatani, Eiji;Shimura, Yuji;Kosugi, Satoru;Tanaka, Hirokazu;Fuchida, Shin-Ichi;Kanda, Junya;Uoshima, Nobuhiko;Kaneko, Hitomi;Imada, Kazunori;Ohta, Kensuke;Ito, Tomoki;Yagi, Hideo;Yoshihara, Satoshi;Hino, Masayuki;Shimazaki, Chihiro;Takaori-Kondo, Akifumi;Kuroda, Junya;Matsumura, Itaru;Kanakura, Yuzuru;Nomura, Shosaku
共分析了129例接受高剂量化疗联合自体干细胞移植（HDT/ASCT）的症状性多发性骨髓瘤（MM）患者。接受维持治疗的患者（n = 82）的4年总生存率（OS）为80%，而未接受维持治疗的患者（n = 47）为72%（p = 0.426）。接受维持治疗的患者的4年无进展生存期（PFS）为38%，而未接受维持治疗的患者为27%（p = 0.088）。多变量分析显示，国际分期系统评分≥2与PFS较差相关（风险比1.62，p = 0.043）。在129例患者中，2例因早期复发而被排除，50例患者达到完全缓解（CR），77例患者未达到CR。达到CR的患者的4年PFS优于未能达到CR的患者（41% vs. 30%，p = 0.027）;但是，4年OS无差异（76% vs. 82%，p = 0.971）。在达到CR的患者中，有/无维持治疗的4年OS为74%/81%（p = 0.357），有/无维持治疗的4年PFS为42%/40%（p = 0.954）。在未能达到CR的患者中，有/无维持的4年OS为97%/91%（p = 0.107），有/无维持的4年PFS为36%/16%（p < 0.001）。在未能达到CR的患者中，维持治疗显著改善了PFS。在真实的世界环境中，HDT/ASCT后的维持治疗可延长未能达到CR的患者的PFS。
A total of 129 symptomatic patients with multiple myeloma (MM) who underwent high‐dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) were analyzed. The 4‐year overall survival (OS) of patients with maintenance (n = 82) was 80%, whereas that of patients without maintenance (n = 47) was 72% (p = 0.426). The 4‐year progression‐free survival (PFS) of patients with maintenance was 38%, whereas that of patients without maintenance was 27% (p = 0.088). Multivariate analysis revealed that an International Staging System score ≥2 was associated with worse PFS (hazard ratio 1.62, p = 0.043). Among the 129 patients, two were excluded owing to early relapse, 50 patients achieved complete response (CR), and 77 patients failed to achieve CR. Patients who achieved CR showed better 4‐year PFS than those who failed to achieve CR (41% vs. 30%, p = 0.027); however, 4‐year OS was not different (76% vs. 82%, p = 0.971). In patients who achieved CR, 4‐year OS with/without maintenance was 74%/81% (p = 0.357), 4‐year PFS with/without maintenance was 42%/40% (p = 0.954). In patients who failed to achieve CR, the 4‐year OS with/without maintenance was 97%/91% (p = 0.107), and 4‐year PFS with/without maintenance was 36%/16% (p < 0.001). In patients who failed to achieve CR, maintenance significantly improved the PFS. Maintenance after HDT/ASCT can prolong PFS in patients who fail to achieve CR in real‐world settings.