Allogeneic stem cell transplantation in patients with multiple myeloma-single center experience.

IF 2 4区 医学 Q3 ONCOLOGY
Tomáš Kříž, Alexandra Jungová, Daniel Lysák, Michal Karas, Marcela Hrabětová, Jiří Šrámek, Pavel Jindra
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引用次数: 0

Abstract

The standard of care in multiple myeloma (MM) consists of induction chemotherapy followed by autologous stem cell transplant (autoSCT), but this setting doesn't present curative potential. Despite advances in new, efficient, and targeted drugs, allogeneic transplant (aloSCT) remains the modality with curative potential in MM. With the knowledge of high mortality and morbidity related to the treatment in comparison to treatment with novel drugs, there is no consensus in the indication of aloSCT in MM, also the choice of ideal patients profiting from this method is difficult. Therefore, we performed a retrospective unicentric study of 36 unselected consecutive patients transplanted for MM in the University Hospital in Pilsen between the years 2000-2020 in order to define possible variables influencing survival. The median age of the patients was 52 years (38-63) and the distribution of MM subtypes was standard. The majority of the patients were transplanted in the relapse setting, 3 (8.3%) patients in the 1st line setting, and in 7 (19%) patients elective auto-alo tandem transplant was performed. 18 patients (60% of patients with available cytogenetics (CG) had high-risk disease. 12 (33.3%) patients were transplanted with chemoresistant disease (at least PR not reached). With a median follow-up of 85 months, we observed median overall survival (OS) of 30 months (range 10-60) and median progression-free survival (PFS) of 15 months (11-175). 1- and 5-year Kaplan Meier survival probabilities for OS were 55% and 30.5% respectively. During the follow-up, 27 (75%) patients died, 11 (35%) due to treatment-related mortality (TRM), and 16 patients (44%) due to a relapse. 9 (25%) patients were still alive, 3 (8.3%) of them with complete remission (CR), and 6 (16.7%) patients with relapse/progression. Altogether 21 (58%) of the patients relapsed/progressed with a median of 11 months (3-175). Incidence of clinically significant acute graft versus host disease (aGvHD gr. >II) was low (8.3%) and extensive chronic GvHD (cGvHD) developed in 4 patients (11.1%). Univariant analysis proved marginal statistical significance in disease status before aloSCT (chemosensitive × chemoresistant) for OS, favoring patients with the chemosensitive disease (HR 0.43, 95% CI 0.18-1.01, p=0.05), there was no significant impact of high-risk cytogenetics (CG) on survival. No other analyzed parameter was found to be significant. Our findings support the conclusion that aloSCT is able to overcome high-risk CG and that aloSCT still remains a valid treatment choice with acceptable toxicity in well-selected high-risk patients with curative potential, even though often with active disease, but not derogating the quality of life significantly.

同种异体干细胞移植在多发性骨髓瘤患者中的应用——单中心经验。
多发性骨髓瘤(MM)的标准治疗包括诱导化疗,然后是自体干细胞移植(autoSCT),但这种设置并不具有治愈潜力。尽管在新的、有效的和靶向的药物方面取得了进展,但同种异体移植(aloSCT)仍然是MM中具有治疗潜力的方式。与新药治疗相比,与治疗相关的死亡率和发病率较高,因此对于MM中aloSCT的适应症没有达成共识,选择从这种方法中获益的理想患者也很困难。因此,我们对2000年至2020年期间在皮尔森大学医院接受MM移植的36例未选择的连续患者进行了回顾性单中心研究,以确定影响生存率的可能变量。患者年龄中位数为52岁(38-63岁),MM亚型分布标准。大多数患者在复发情况下进行了移植,3例(8.3%)患者在一线情况下进行了移植,7例(19%)患者进行了选择性自体-串联移植。18例患者(60%的可用细胞遗传学(CG)患者有高危疾病。12例(33.3%)移植患者伴有化疗耐药(至少未达到PR)。中位随访85个月,我们观察到中位总生存期(OS)为30个月(范围10-60),中位无进展生存期(PFS)为15个月(11-175)。OS的1年和5年Kaplan Meier生存率分别为55%和30.5%。随访期间,27例(75%)患者死亡,11例(35%)患者死于治疗相关死亡率(TRM), 16例(44%)患者死于复发。9例(25%)患者仍然存活,3例(8.3%)患者完全缓解(CR), 6例(16.7%)患者复发/进展。共有21例(58%)患者复发/进展,中位时间为11个月(3-175)。具有临床意义的急性移植物抗宿主病(aGvHD gr. >II)发生率较低(8.3%),4例患者(11.1%)发展为广泛的慢性移植物抗宿主病(cGvHD)。单变量分析证实,OS患者在行化疗前的疾病状态(化疗敏感×化疗耐药)有边际统计学意义,有利于化疗敏感患者(HR 0.43, 95% CI 0.18-1.01, p=0.05),高危细胞遗传学(CG)对生存率无显著影响。没有其他分析参数被发现是显著的。我们的研究结果支持这样的结论,即aloSCT能够克服高风险的CG,并且aloSCT仍然是一种有效的治疗选择,对于有治疗潜力的精选高风险患者,即使经常伴有活动性疾病,其毒性也可以接受,但不会显著降低生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neoplasma
Neoplasma 医学-肿瘤学
CiteScore
5.40
自引率
0.00%
发文量
238
审稿时长
3 months
期刊介绍: The journal Neoplasma publishes articles on experimental and clinical oncology and cancer epidemiology.
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