自体造血干细胞移植后早期复发对新诊断多发性骨髓瘤预后的影响

目的:评估自体造血干细胞移植(AHSCT)后早期复发对新诊断多发性骨髓瘤(MM)患者生存的影响。方法:回顾性分析2012年1月至2017年12月在山西白求恩医院血液科接受AHSCT治疗的37例新诊断MM患者的临床资料,分析移植后早期复发(移植后复发<12个月)对总生存期(OS)的影响,同时分析国际分期系统分期、细胞遗传学、移植前疗效、移植后微小残留病和移植年龄对OS的影响。结果:37例患者中,早期复发13例(35.1%),未早期复发24例(64.9%)。早期复发患者中有3例合并髓外病变,未早期复发患者无一例合并髓外病变。移植前,在早期复发和未早期复发患者中≥非常好的部分缓解(VGPR)率分别为23.1%(3例)和62.5%(15例),前者的疗效较差,比较差异有统计学意义(P<0.05)。所有患者中位随访时间31(12-96)个月,中位OS时间为93个月。早期复发患者与未早期复发患者中位OS时间分别为17和93个月,中位疾病无进展生存期分别为7和38个月,比较差异均有统计学意义(P<0.05)。单因素分析显示,影响OS的因素有早期复发、高危细胞遗传学和移植前疗效≥VGPR。多因素分析显示,只有早期复发是预后的独立影响因素。结论:多发性骨髓瘤自体造血干细胞移植后早期复发患者预后差,早期复发是影响患者生存的独立预后因素。

The Prognostic Value of Early Relapse after Autologous Hematopoietic Stem Cell Transplantation in Newly Diagnosed Multiple Myeloma

Objective:To assess the impact of early relapse(ER)after autologous hematopoietic stem cell transplantation(AHSCT)on overall survival(OS)for multiple myeloma(MM)patients.Methods:Clinical data of 37 patients with MM undergoing AHSCT in department of hematology of Shanxi Bethune Hospital from January 2012 to December2017 were retrospectively analyzed.The effect of ER on OS of patients was analyzed.The effects of international staging system(ISS)staging,cytogenetics,pre-transplant efficacy,minimal residual disease,and age on OS of the patients were also analyzed respectively.Results:Among the 37 patients,13 cases(35.1%)had ER,and 24 cases(64.9%)had non-ER.3 patients with ER had extramedullary disease,but none with non-ER showed extramedullary disease.More than or equal to very good partial rate(VGPR)in patients with ER and without ER were 3 cases(23.1%)and 15 cases(62.5%),respectively,and the curative effect of the former was significantly lower than that of the latter(P<0.05).The median follow-up time was 31(12-96)months,and median OS time was 93 months in all the patients.The median survival time of patients with ER was 17 months,and the median progression free survival was 7 months,both were significantly shorter than 93 months and 38 months of patients with non-ER(P<0.05).Univariate analysis showed that the OS was affected by ER,cytogenetic abnormalities(FISH),and≥VGPR before transplantation.Multivariate analysis showed that ER was an independent prognostic factor.Conclusion:The prognosis of patients with ER after AHSCT in newly diagnosed MM is poor.ER is an independent prognostic factor of survival.