Allogeneic marrow transplantation for multiple myeloma: An analysis of risk factors on outcome
Allogeneic marrow transplantation for multiple myeloma: An analysis of risk factors on outcome
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DOI：
10.1182/blood.v88.7.2787.bloodjournal8872787
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发表时间：
1996-10-01
期刊：
影响因子：
20.3
通讯作者：
Appelbaum, FR
中科院分区：
文献类型：
--
作者：
Bensinger, WI;Buckner, CD;Appelbaum, FR
1987年9月至1994年12月间，80例多发性骨髓瘤（MM）患者接受了大剂量白消安和环磷酰胺治疗，其中57例未接受或23例接受了改良全身照射，随后接受了异基因供者的骨髓。在移植时，71%的患者患有化疗难治性疾病，35名患者在100天内死于移植相关原因，11名患者在之后死亡。4.5年时生存率和无进展生存率的精算概率分别为0.24 +/-0.17和0.20 +/-0.10。36%的患者获得了完全缓解，这些患者在4.5年时的精算生存概率和无事件生存概率分别为0.50 +/-0.21和0.43 +/-0.17。在多变量分析中，结果终点的不良风险因素包括：移植超过1年诊断; β-2微球蛋白> 2.5移植时;女性患者从男性供体移植;患者在移植前接受了超过8个周期的化疗和Durie 3期疾病在移植时。这些结果表明，MM患者的同种异体移植可使少数患者获得长期无病生存。降低移植相关死亡率的努力应侧重于早期移植、毒性较低的治疗方案、更好的支持性护理以及改善移植物抗宿主病（GVHD）的预防和治疗。(C)1996年，美国血液学会。
Between September 1987 and December 1994, 80 patients with multiple myeloma (MM) received high-dose busulfan and cyclophosphamide without in = 57) or with modified total body irradiation in = 23) followed by marrow from allogeneic donors. At transplant, 71% of the patients had disease that was refractory to chemotherapy, Thirty-five patients died of transplant-related causes within 100 days and 11 deaths occurred later. The actuarial probabilities of survival and progression-free survival were .24 +/- 0.17 and .20 +/- 0.10 at 4.5 years. Complete remissions were obtained in 36% of patients who had actuarial probabilities of survival and event-free survival of .50 +/- 0.21 and .43 +/- 0.17 at 4.5 years. In a multivariate analysis, adverse risk factors for outcome endpoints included: transplantation greater than 1 year from diagnosis; beta-2 microglobulin >2.5 at transplant; female patients transplanted from male donors; patients who had received greater than eight cycles of chemotherapy before transplant and Durie stage 3 disease at the time of transplant. These results indicate that allografting for patients with MM can result in long-term disease-free survival for a minority of patients. Efforts to reduce transplant-related mortality should focus on earlier transplantation, less toxic treatment regimens, better supportive care, and improved prevention and treatment of graft-versus-host disease (GVHD). (C) 1996 by The American Society of Hematology.