肾功能受损的多发性骨髓瘤患者自体干细胞移植的存活率微乎其微:对前抗体时代的批判性评估。

IF 3.2 4区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Yan Li, Xinyi Zhang, Zhongqing Zou, Yanqiu Xiong, Xinyuan Gu, Ruiji Zou, Jing Tan, Li Zhang, Yuhuan Zheng, Ting Niu
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引用次数: 0

摘要

对肾功能不全(RI)的多发性骨髓瘤(MM)患者进行大剂量美罗华后自体造血干细胞移植(HDM-ASCT)的益处存在争议。为了评估HDM-ASCT对肾功能不全多发性骨髓瘤患者的安全性和有效性,我们进行了系统综述和荟萃分析,并将研究结果与真实世界的数据进行了比较。研究共纳入了 26 篇文章,其中 13 篇文章被汇总进行了荟萃分析。我们将三种不同类型的 RI MM 患者与肾功能正常 (NRF) 的 MM 患者进行了比较。这些患者是移植时患有 RI 的 MM 患者;诊断时患有 RI 的 MM 患者;诊断时患有 RI 但移植时肾功能正常的 MM 患者。荟萃分析表明,使用美法仑≤140 mg/m2治疗RI并随后进行ASCT的MM患者的移植相关死亡率与无RI的患者相当。接受RIs治疗的MM患者和接受NRF治疗的MM患者在ASCT后的完全缓解率相似。虽然两组患者的无进展生存期(PFS)在统计学上相似,但RIs MM患者的总生存期(OS)明显低于NRF患者。真实世界的数据支持这些发现。在减少美法仑剂量的情况下,ASCT 对患有 RI 的 MM 患者是安全有效的。与NRF MM患者相比,RI MM患者的完全反应率和ASCT后的PFS相似。有RI的MM患者的OS较低,这表明需要进一步研究以改善这些患者的OS。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Modest survival benefits of autologous stem cell transplantation in multiple myeloma with renal impairment: a critical appraisal of the pre-antibody era.

Modest survival benefits of autologous stem cell transplantation in multiple myeloma with renal impairment: a critical appraisal of the pre-antibody era.

The benefit of high-dose melphalan followed by autologous hematopoietic stem cell transplantation (HDM-ASCT) for multiple myeloma (MM) patients with renal insufficiency (RI) is debated. A systematic review and meta-analysis were conducted to assess the safety and efficacy of HDM-ASCT in MM patients with RIs, and the findings were compared with real-world data. The study included 26 articles, 13 of which were pooled for meta-analysis. We compared three different types of MM patients with RI against MM patients with normal renal function (NRF). These patients were: MM patients with RI at the time of transplantation; MM patients with RI at the time of diagnosis; MM patients with RI at diagnosis but with NRF at transplantation. The meta-analysis indicated that MM patients with RIs conditioned with melphalan ≤ 140 mg/m2 followed by ASCT had transplant-related mortality rates comparable to those without RIs. The complete response rates post-ASCT were similar between MM patients with RIs and those with NRF. Although progression-free survival (PFS) was statistically similar between the groups, MM patients with RIs had significantly poorer overall survival (OS) than those with NRF. The real-world data supported these findings. With a reduced dose of melphalan, ASCT is safe and effective for MM patients with RI. MM patients with RI have similar complete response rates and PFS after ASCT compared to MM patients with NRF. The lower OS in MM patients with RI indicates the need for further research to improve OS in these patients.

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来源期刊
Clinical and Experimental Medicine
Clinical and Experimental Medicine 医学-医学:研究与实验
CiteScore
4.80
自引率
2.20%
发文量
159
审稿时长
2.5 months
期刊介绍: Clinical and Experimental Medicine (CEM) is a multidisciplinary journal that aims to be a forum of scientific excellence and information exchange in relation to the basic and clinical features of the following fields: hematology, onco-hematology, oncology, virology, immunology, and rheumatology. The journal publishes reviews and editorials, experimental and preclinical studies, translational research, prospectively designed clinical trials, and epidemiological studies. Papers containing new clinical or experimental data that are likely to contribute to changes in clinical practice or the way in which a disease is thought about will be given priority due to their immediate importance. Case reports will be accepted on an exceptional basis only, and their submission is discouraged. The major criteria for publication are clarity, scientific soundness, and advances in knowledge. In compliance with the overwhelmingly prevailing request by the international scientific community, and with respect for eco-compatibility issues, CEM is now published exclusively online.
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