Reduced-intensity conditioning for myeloma:: lower nonrelapse mortality but higher relapse rates compared with myeloablative conditioning
Reduced-intensity conditioning for myeloma:: lower nonrelapse mortality but higher relapse rates compared with myeloablative conditioning
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DOI：
10.1182/blood-2006-07-036848
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发表时间：
2007-04-15
期刊：
影响因子：
20.3
通讯作者：
Gahrton, Gosta
中科院分区：
文献类型：
--
作者：
Crawley, Charles;Iacobelli, Simona;Gahrton, Gosta
尽管降低强度预处理 (RIC) 广泛用于治疗骨髓瘤，但很少有数据将 RIC 与清髓性预处理 (MAC) 的结果进行比较。我们报告接受同种异体骨髓瘤移植的患者的结果并向 EBMT 报告。 1998 年至 2002 年间进行的 320 例 RIC 和 196 例 MAC 同种异体移植的最小数据集可用。RIC 患者年龄较大（51 岁 vs 45 岁），疾病进展更严重（28% vs 21%），更多患者之前接受过移植（76% vs 11%）。此外，移植时间更长，外周血和 T 细胞消耗的使用增加。对于 RIC 和 MAC，2 年时的非复发死亡率 (NRM) 分别为 24% 和 37% (P = .002)；总生存率，38.1% 和 50.8%（不显着 [ns]）；无进展生存期 (PFS) 分别为 18.9% 和 34.5% (P = .001)。在多变量分析中，RIC 与 NRM 降低相关（HR，0.5），但这被复发风险的增加所抵消（HR，2.0），并且调节强度不会影响总体生存或保留 PFS 的显着性。这些数据表明，需要持续研究骨髓瘤同种异体移植物调理中的剂量强度。
Despite the widespread adoption of reduced-intensity conditioning (RIC) for myeloma, there are few data comparing outcomes with RIC with myeloablative conditioning (MAC). We report the outcomes of patients undergoing allogeneic transplantations for myeloma and reported to the EBMT. A minimum data set was available on 320 RIC and 196 MAC allografts performed between 1998 and 2002. The RIC patients were older (51 vs 45 years) with more progressive disease (28% vs 21%) and more had received a prior transplant (76% vs 11%). In addition, there was a longer time to transplantation and an increased use of peripheral blood and T-cell depletion. For RIC and MAC, respectively, the nonrelapse mortality (NRM) at 2 years was 24% and 37% (P = .002); overall survival, 38.1% and 50.8% (not significant [ns]); and progression-free survival (PFS), 18.9% and 34.5% (P = .001). On multivariate analysis, RIC was associated with a reduction in NRM (HR, 0.5), but this was offset by an increase in relapse risk (HR, 2.0), and the conditioning intensity did not impact on overall survival or retain significance for PFS. These data suggest that there is a continuing need to investigate dose intensity in the conditioning for myeloma allografts.