Second Autologous Stem Cell Transplant: An Effective Therapy for Relapsed Multiple Myeloma
Second Autologous Stem Cell Transplant: An Effective Therapy for Relapsed Multiple Myeloma
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DOI：
10.1016/j.bbmt.2014.11.677
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发表时间：
2015-03-01
影响因子：
4.3
通讯作者：
Landau, Heather
中科院分区：
文献类型：
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作者：
Abbi, Kamal Kant Singh;Zheng, Junting;Landau, Heather
对于既往自体干细胞移植（ASCT）后病情复发的多发性骨髓瘤（MM）患者，治疗选择包括扩大新型药物的治疗范围，通常与传统化疗或第二次ASCT联合使用，没有明确的治疗标准。我们回顾性分析了1995年至2012年间在纪念斯隆-凯特琳癌症中心接受基于美法仑的ASCT治疗复发性MM的75例患者的结局。使用美法仑200 mg/m2（n = 43）、180 mg/m2（n = 1）、140 mg/m2（n = 22）和100 mg/m2（n = 9）进行预处理。第二次ASCT时的中位年龄为59岁（范围：36 - 75岁），58%（n = 35）为男性。在有可用数据的患者中，19%在第二次ASCT时具有高风险细胞遗传学（包括t（4;14），p53丢失或del 13 q核型）。首次ASCT与补救ASCT之间的中位间隔为37.5个月（范围：6.9 - 111.4）。在72例可评估的患者中，57%在补救性ASCT之前患有化疗敏感性疾病，43%为化疗耐药。在ASCT后2至3个月评估缓解情况，在71例可评估患者中，82%至少达到部分缓解，15%病情稳定，3%尽管接受了补救性ASCT，但仍有进展。补救性ASCT后，38例患者接受维持治疗，14例患者继续接受同种异体ASCT。第二次自体移植后的中位无进展生存期（PFS）为10.1个月（95%置信区间[CI]，7.6至13.4），中位总生存期（OS）为22.7个月（95% CI，19.2至41.2）。与耐药复发患者相比，化疗敏感复发患者的PFS有更好的趋势（风险比[HR]，0.60 [95% CI，0.36至1.02]; P = 0.058），OS显著延长（HR，0.49 [95% CI，0.27至0.88]; P = 0.017）。与具有标准风险细胞遗传学的患者相比，在第二次ASCT时具有高风险细胞遗传学的患者具有更高的死亡风险（HR，2.98 [95% CI，1.28至6.97]; P = 0.012）。补救性ASCT是治疗复发性MM伴化学敏感性疾病的有效策略，其PFS和OS与其他补救策略相当。(C)2015年美国血液和骨髓移植协会。
Therapeutic options for patients with multiple myeloma (MM) whose disease has relapsed after a prior autologous stem cell transplant (ASCT) include an expanding armamentarium of novel agents, often combined with traditional chemotherapy, or a second ASCT, with no clear standard of care. We retrospectively analyzed the outcomes of 75 patients who underwent salvage melphalan-based ASCT for relapsed MM at Memorial Sloan-Kettering Cancer Center between 1995 and 2012. Conditioning was performed with melphalan 200 mg/m(2) (n = 43), 180 mg/m(2) (n = 1), 140 mg/m(2) (n = 22), and 100 mg/m(2) (n = 9). The median age at second ASCT was 59 years (range, 36 to 75), and 58% (n = 35) were men. Of those with available data, 19% had high-risk cytogenetics (including t (4;14), p53 loss, or del 13q by karyotype) at the time of second ASCT. Median interval between first and salvage ASCT was 37.5 months (range, 6.9 to 111.4). Of 72 assessable patients, 57% had chemotherapy-sensitive disease before to salvage ASCT and 43% were chemoresistant Four patients died within 100 days of ASCT. Response was assessed at 2 to 3 months post-ASCT, and of 71 assessable patients, 82% achieved at least a partial response, 15% had stable disease, and 3% progressed despite salvage ASCT. After salvage ASCT, 38 patients received maintenance therapy and 14 went on to allogeneic ASCT. The median progression-free survival (PFS) after second autograft was 10.1 months (95% confidence interval [CI], 7.6 to 13.4) and median overall survival (OS) 22.7 months (95% Cl, 19.2 to 41.2). Patients with chemosensitive relapse had a trend toward better PFS (hazard ratio [HR], .60 [95% CI, .36 to 1.02]; P = .058) and significantly longer OS (HR, .49 [95% CI, .27 to .88]; P = .017) than patients with resistant relapse. Those with high-risk cytogenetics at the time of second ASCT had higher risk of death (HR, 2.98 [95% Cl, 1.28 to 6.97]; P = .012) compared with patients with standard-risk cytogenetics. Salvage ASCT is an effective strategy for relapsed MM with chemosensitive disease and results in comparable PFS and OS to other salvage strategies. (C) 2015 American Society for Blood and Marrow Transplantation.