Complete response correlates with long-term survival and progression-free survival in high-dose therapy in multiple myeloma
Complete response correlates with long-term survival and progression-free survival in high-dose therapy in multiple myeloma
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DOI：
10.3324/haematol.11534
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发表时间：
2007-10-01
期刊：
影响因子：
10.1
通讯作者：
Bayssas, Martine
中科院分区：
文献类型：
--
作者：
van de Velde, Helgi J. K.;Liu, Xiangyang;Bayssas, Martine
文献数据中有许多关于多发性骨髓瘤患者接受高剂量治疗和自体干细胞移植（HDT/SCT）治疗的长期结局的报告。虽然这些数据总体上支持最大肿瘤缓解与HDT/SCT后总生存期或无进展生存期之间的相关性，但一些试验未能发现这种相关性，并且最近没有对该问题进行全面的文献分析。因此，我们进行了一项全面的文献综述，以确定一线多发性骨髓瘤中HDT/SCT的前瞻性和回顾性研究，其中根据观察到的最佳肿瘤缓解报告了长期结局。根据前瞻性定义的检索策略，我们确定了21项研究（10项前瞻性研究和11项回顾性研究），其中报告了4，990例HDT/SCT患者的最佳肿瘤缓解结局。大多数研究表明HDT/SCT期间或之后的最大缓解与长期结局（总生存期和无事件/无进展生存期）之间存在相关性。个体研究报告中关于诱导治疗后最大缓解与长期结局之间相关性的结论差异更大，可能是由于每项个体研究中标准诱导治疗后完全缓解率较低。因此，我们进行了两种类型的荟萃分析，一种是基于个体研究中报告的这些相关性的p值，另一种是基于个体研究中提供的主要缓解和结局数据。两项荟萃分析均表明，HDT/SCT期间或之后的最大缓解（完全缓解/接近完全缓解/非常好的部分缓解）与长期结局（总生存期和无事件/无进展生存期）之间存在高度显著相关性。两项荟萃分析还提供了诱导治疗后最大缓解与长期结局（总生存期和无事件/无进展生存期）之间高度显著相关的证据。
There are a number of reports in literature data on the long-term outcomes of patients with multiple myeloma treated with high-dose therapy and autologous stem cell transplantation (HDT/SCT). While in general these data support the association between maximal tumor response and overall survival or progression-free survival after HDT/SCT, some trials have failed to find such correlation and there is no recent comprehensive literature analysis of this issue. We, therefore, performed a comprehensive literature review to identify prospective and retrospective studies on HDT/SCT in frontline multiple myeloma in which long-term outcomes were reported according to best tumor response observed. Following a prospectively defined search strategy we identified 21 studies (10 prospective and 11 retrospective studies) in which outcomes of 4,990 HDT/SCT patients according to their best tumor response were reported. The majority of these studies indicated a correlation between maximal response during or after HDT/SCT and long-term outcomes (overall survival and eventfree/progression-free survival). The conclusions in individual studis report on the association between maximal response following induction therapy and long-term outcomes were more heterogeneous, possibly due to the low rate of complete response after standard induction therapy in each individual study. We, therefore, performed two types of meta-analyses, one based on the p-values reported for these associations in the individual studies, and one based on the primary response and outcome data provided in the individual studies. Both meta-analyses indicated highly significant associations between maximal response (complete response/near complete response/very good partial response) during or after HDT/SCT and long-term outcomes (overall survival and event-free/progression-free survival). Both meta-analyses also provided evidence of highly significant associations between maximal response following induction therapy and long-term outcomes (overall survival and event-free/progression-free survival).