Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era.
Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era.
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新型药物时代的自体干细胞移植前检测骨髓瘤中的风险分层。
DOI：
10.1038/bcj.2016.117
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发表时间：
2016-12-16
影响因子：
12.8
通讯作者：
Gertz MA
中科院分区：
文献类型：
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作者：
Chakraborty R;Muchtar E;Kumar SK;Jevremovic D;Buadi FK;Dingli D;Dispenzieri A;Hayman SR;Hogan WJ;Kapoor P;Lacy MQ;Leung N;Gertz MA
在自体干细胞移植(ASCT)治疗多发性骨髓瘤之前，循环浆细胞(CPC)的影响在新的药物时代还没有确定。我们用六色流式细胞术检测了早期ASCT患者移植前CPC对移植后反应、无进展生存期(PFS)和总生存期(OS)的影响。在840例患者中检出CPC 162例(19.3%)，中位数为每150个 事件58个CPC。99%的患者接受了基于蛋白酶体抑制剂和/或免疫调节剂的诱导。移植后严格完全应答(SCR)的发生率在有无CPC的亚组中分别为15%和38%(P<；0.001)。中位生存期分别为15.1个月(95%可信区间，12.5~17.8)和29.6个月(95%可信区间，2 6.2~32.8)，中位OS分别为41.0个月(95%可信区间，32.6~58.2)和未达(95%可信区间，99.1-NR)(P<；两者均为0.001)。在OS的多变量分析中，独立预测死亡率的因素是移植后CPC的存在(风险比(HR)2.5；95%CI，1.8-3.6；P<；0.001)和Scr(HR 0.4；95%CI，0.2-0.6；P<；0.001)。移植前CPC的存在对预后有很高的影响，应该在临床试验中进行前瞻性的验证。
The impact of circulating plasma cells (CPCs) prior to autologous stem cell transplantation (ASCT) for multiple myeloma has not been defined in the novel agent era. We evaluated the impact of pre-transplant CPCs, detected by six-color flow cytometry in patients undergoing early ASCT on post-transplant response, progression-free survival (PFS) and overall survival (OS). CPCs were detected in 162 out of 840 (19.3%) patients, with the median number of CPCs being 58 per 150 000 events. Ninety-nine percent of patients had received proteasome inhibitor and/or immunomodulator-based induction. The incidence of post-transplant stringent complete response (sCR) in the subgroups with and without CPCs was 15% and 38%, respectively, (P<0.001). The median PFS in the subgroups with and without CPCs was 15.1 (95% confidence interval (CI), 12.5–17.8) and 29.6 months (95% CI, 26.2–32.8), respectively, and the median OS was 41.0 months (95% CI, 32.6–58.2) and not reached (NR) (95% CI, 99.1-NR), respectively, (P<0.001 for both). On multivariate analysis for OS, factors independently predictive of mortality were the presence of CPCs (hazard ratio (HR) 2.5; 95% CI, 1.8–3.6; P<0.001) and sCR post transplant (HR 0.4; 95% CI, 0.2–0.6; P<0.001). Presence of CPCs prior to transplant has a high prognostic impact and should be prospectively validated in clinical trials.