Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time.
Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time.
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DOI：
10.1038/leu.2017.331
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发表时间：
2018-04
期刊：
影响因子：
11.4
通讯作者：
D'Souza A
中科院分区：
文献类型：
--
作者：
Kumar SK;Dispenzieri A;Fraser R;Mingwei F;Akpek G;Cornell R;Kharfan-Dabaja M;Freytes C;Hashmi S;Hildebrandt G;Holmberg L;Kyle R;Lazarus H;Lee C;Mikhael J;Nishihori T;Tay J;Usmani S;Vesole D;Vij R;Wirk B;Krishnan A;Gasparetto C;Mark T;Nieto Y;Hari P;D'Souza A
初始疾病反应的持续时间仍然是多发性骨髓瘤 (MM) 的一个重要预后因素，特别是对于前期自体造血细胞移植 (AHCT) 受者而言。我们假设 AHCT 之前以及 AHCT 复发后使用的新药物类别和组合可能改变了该人群中 MM 的自然史。我们分析了国际血液和骨髓移植研究中心数据库，以跟踪诊断后 12 个月内接受单次 AHCT 的 MM 患者 (N=3,256) 和 AHCT 后早期复发（<24 个月）的总生存期 (OS)，并确定预测早期复发与晚期复发（AHCT 后 24-48 个月）的因素。在 3 个时期（2001-2004、2005-2008、2009-2013）中，患者特征是平衡的，除了 III 期比例较低、采用新三胞胎进行 1 次诱导治疗的可能性较高以及随时间推移计划的 AHCT 维持率较高之外。随着时间的推移，早期复发的患者比例稳定在 35-38%。降低早期复发风险的因素包括分期较低、化疗敏感性、2008 年之后的移植以及 AHCT 后的维持。较短的复发后 OS 与早期复发、IgA MM、Karnofsky <90、III 期、>1 线诱导和缺乏维持相关。 AHCT 后早期复发仍然是一个不良的预后因素，尽管结果随着时间的推移有所改善。
Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM) particularly for upfront autologous hematopoietic cell transplant (AHCT) recipients. We hypothesized that new drug classes and combinations employed prior to AHCT as well as after post-AHCT relapse may have changed the natural history of MM in this population. We analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of MM patients receiving single AHCT within 12 months after diagnosis (N=3,256) and relapsing early post-AHCT (<24 months), and to identify factors predicting for early vs. late relapses (24–48 months post-AHCT). Over 3 periods (2001–2004, 2005–2008, 2009–2013), patient characteristics were balanced except for lower proportion of Stage III, higher likelihood of 1 induction therapy with novel triplets and higher rates of planned post-AHCT maintenance over time. The proportion of patients relapsing early was stable over time at 35–38%. Factors reducing risk of early relapse included lower stage, chemosensitivity, transplant after 2008 and post-AHCT maintenance. Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, stage III, >1 line of induction and lack of maintenance. Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time.
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DOI：
10.1182/asheducation-2016.1.485
发表时间：
2016-12-01
影响因子：
3
作者：
Dispenzieri, Angela
通讯作者：
Dispenzieri, Angela
影响因子：
20.3
作者：
Kuiper, Rowan;van Duin, Mark;Sonneveld, Pieter
通讯作者：
Sonneveld, Pieter
影响因子：
11.4
作者：
Durie, B. G. M.;Harousseau, J-L;Rajkumar, S. V.
通讯作者：
Rajkumar, S. V.
影响因子：
8.9
作者：
Mikhael, Joseph R.;Dingli, David;Lacy, Martha Q.
通讯作者：
Lacy, Martha Q.
影响因子：
4.3
作者：
Hari, Parameswaran N.;McCarthy, Philip L.
通讯作者：
McCarthy, Philip L.