A comparison of allografting with autografting for newly diagnosed myeloma
A comparison of allografting with autografting for newly diagnosed myeloma
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DOI：
10.1056/nejmoa065464
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发表时间：
2007-03-15
影响因子：
158.5
通讯作者：
Boccadoro, Mario
中科院分区：
文献类型：
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作者：
Bruno, Benedetto;Rotta, Marcello;Boccadoro, Mario
背景：在这项治疗新诊断的多发性骨髓瘤的试验中，我们比较了一种方案，即先进行自体造血干细胞移植，然后移植一个人类白细胞抗原相合的同胞的同种异体移植，然后再进行串联自体移植。方法：我们招募了162名年龄在65岁或以下且至少有一个兄弟姐妹的新诊断骨髓瘤患者。所有患者最初都接受了长春新碱、阿霉素和地塞米松的治疗，然后是马法兰和自体干细胞拯救。然后，人类白细胞抗原相合同胞的患者接受非清髓性全身照射和来自兄弟姐妹的干细胞。没有人类白细胞抗原相合同胞的患者接受了两次连续的清髓剂量的马法兰，每一次之后都进行了自体干细胞挽救。结果：经过中位时间45个月(21~90个月)的随访，80例患者的中位总生存期和无事件生存期均长于82例非相合患者(分别为80个月和54个月，P=0.01；35个月和29个月，P=0.02)。在完成指定治疗方案的患者中，双自体移植组(46例)和自体同种异体移植组(58例，P=0.09)之间的治疗相关死亡率没有显著差异，但双自体移植组的疾病相关死亡率显著高于(43%对7%，P
BACKGROUND:In this trial of the treatment of newly diagnosed multiple myeloma, we compared a protocol that entailed a hematopoietic stem-cell autograft followed by an allograft from an HLA-identical sibling with a protocol of tandem autografts.METHODS:We enrolled 162 consecutive patients with newly diagnosed myeloma who were 65 years of age or younger and who had at least one sibling. All patients were initially treated with vincristine, doxorubicin, and dexamethasone, followed by melphalan and autologous stem-cell rescue. Patients with an HLA-identical sibling then received nonmyeloablative total-body irradiation and stem cells from the sibling. Patients without an HLA-identical sibling received two consecutive myeloablative doses of melphalan, each of which was followed by autologous stem-cell rescue. The primary end points were overall survival and event-free survival.RESULTS:After a median follow-up of 45 months (range, 21 to 90), the median overall survival and event-free survival were longer in the 80 patients with HLA-identical siblings than in the 82 patients without HLA-identical siblings (80 months vs. 54 months, P=0.01; and 35 months vs. 29 months, P=0.02, respectively). Among patients who completed their assigned treatment protocols, treatment-related mortality did not differ significantly between the double-autologous-transplant group (46 patients) and the autograft-allograft group (58 patients, P=0.09), but disease-related mortality was significantly higher in the double-autologous-transplant group (43% vs. 7%, P