自体造血干细胞移植可使中国高危多发性骨髓瘤患者获益更多

目的 评价自体造血干细胞移植（ASCT）对初治多发性骨髓瘤（MM）的疗效.方法 选取诱导治疗后获得部分缓解（PR）及以上疗效的42例初治MM患者进行ASCT,中位随访34.2个月后,观察患者的疗效、无进展生存（PFS）和总生存（OS）.选择同时期的49例诱导治疗后获得PR及以[上疗效的初治MM患者,进入非移植组（non-ASCT）,经巩固维持治疗后观察疗效、PFS和OS,比较两组的差异,分析ASCT在MM中的作用.结果 与non-ASCT组相比,ASCT可明显延长患者的OS（未达到/37.2个月,P=O.000）,而且对PFS也有延长趋势（33.9个月/39.8个月,P=0.133）.ASCT可明显改善DSⅢ期（P=0.009）和ISSⅢ期（P=0.049）患者PFS,但对DSⅠ /Ⅱ期和ISS Ⅰ/Ⅱ期患者的PFS改善不明显.ASCT可明显改善诱导治疗后获得CR患者的PFS（P=0.016）,对非常好的PR （VGPR） /PR患者的PFS改善不明显;不同年龄患者OS均明显改善（≤55岁,P=0.039;＞ 55岁,P=0.000）.ASCT可明显改善不同ISS分期患者的OS（Ⅰ/Ⅱ期,P=0.003;Ⅲ期,P=0.012）,对DSⅢ期患者的OS也有明显改善作用（P=0.000）,但对DSⅠ/Ⅱ期患者OS的作用不明显（P=0.446）.诱导治疗后获得CR和VGPR/PR的患者进行移植后,OS可进一步得到改善（CR,P=0.004; VGPR/PR,P=0.004）.结论 ASCT可明显改善初治MM患者的生存,使高龄和分期预后不良的MM患者获益更多.

Chinese multiple myeloma patients at high risk benefit more from autologous stem cell transplantation

Objective To evaluate effects of autologous stem cell transplantation （ASCT） on new diagnosed multiple myeloma （MM） patients.Methods 42 newly diagnosed MM patients who obtained partial remission （PR） or better and received ASCT were selected.With a median 34.2 months follow-up,therapeutic effects,progression-free survival （PFS） and overall survival （OS） of 42 newly diagnosed patients received ASCT were analyzed.49 patients who obtained PR or better after induction therapy but not received ASCT were selected as control.The differences of these two groups were analyzed and effects of ASCT on new diagnosed MM patients were evaluated.Results Compared with non-ASCT patients,patients received ASCT had longer OS （not reached vs 37.2 months,P =0.000）.ASCT could also prolonged PFS of MM patients,but there was not significant difference （33.9 months vs 39.8 months,P =0.133）.ASCT could significantly improved PFS of MM patients with DS Ⅲ stage （P =0.009） and ISS Ⅲ stage （P =0.049）,however,it could improve PFS of DS Ⅰ /Ⅱ stage and ISS Ⅰ/Ⅱ] stage.ASCT could significantly improve PFS of patients obtained complete remission （CR） （P =0.016）,however,it had not significant effect on patients obtained very good PR （VGPR） or PR after induction therapy.ASCT could significantly improved OS of patients aged ≤55 years old （P =0.039） and 〉 55 years old （P =0.000）.ASCT could significantly improved OS of MM patients with ISS Ⅰ /Ⅱ stage （P =0.003）,ISS Ⅲ stage （P =0.012） and DS Ⅲ stage （P =0.000）,however,it had not significant effect on patients with DSⅠ/ Ⅱ] stage （P =0.446）.After induction therapy,ASCT could further improved OS of patients obtained CR （P =0.004） or VGPR/PR （P =0.004）.Conclusion ASCT could significantly improve OS of new diagnosed MM patients and could make MM patients obtaine more benefits who are at high risk at age and stages.