第二次自体干细胞移植对复发多发性骨髓瘤的影响:法国多中心真实生活研究。

IF 7.6 2区 医学 Q1 HEMATOLOGY HemaSphere Pub Date : 2024-07-29 DOI:10.1002/hem3.106
Axel André, Lydia Montes, Damien Roos-Weil, Laurent Frenzel, Marguerite Vignon, Thomas Chalopin, Pierre-Edouard Debureaux, Alexis Talbot, Agathe Farge, Fabrice Jardin, Karim Belhadj, Bruno Royer, Jean-Pierre Marolleau, Bertrand Arnulf, Pierre Morel, Stéphanie Harel
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引用次数: 0

摘要

复发多发性骨髓瘤(RMM)患者在第一次自体干细胞移植(ASCT)后出现长期反应,可考虑进行第二次自体干细胞移植(ASCT2)。然而,鉴于抗CD38和免疫疗法等突破性治疗方法,其作用仍存在争议。我们在法国的10个中心开展了一项实际研究(1996-2017年),共有267名RMM患者接受了ASCT2。中位年龄为61岁,女性占49%。大多数患者在ASCT2前接受了美法仑200 mg/m²治疗,早期死亡率较低(1%)。ASCT2后的部分反应非常好或更好(VGPR+)率为78%。ASCT2后,48%的患者接受了巩固治疗,40%接受了维持治疗。ASCT2后的中位无事件生存期(EFS)为2.6年(95%置信区间[CI]:2.3-2.8),2年EFS估计值为63%(95% CI:57-70)。中位总生存期(OS)为8.1年(95% CI:5.9-NA),2年OS估计值为92%(95% CI:88-95)。多变量分析显示,VGPR+ 状态和 ASCT2 后的维持治疗与较好的 EFS 相关(危险比 [HR]:HR:0.6;95% CI:0.3-0.9,P = 0.012;HR:0.4;95% CI:0.3-0.6,P = 0.017;HR:0.2;95% CI:0.1-0.4,P = 0.002)。总体而言,ASCT2在RMM患者中疗效显著,毒性较低。维持治疗与延长 EFS 和 OS 相关,尤其是在 ASCT2 后 VGPR+ 状态的患者中。这些发现强调了ASCT2在RMM中的潜力,如果在选定的患者中配合维持治疗的话。
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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Impact of second autologous stem-cell transplantation at relapsed multiple myeloma: A French multicentric real-life study

A second autologous stem-cell transplantation (ASCT2) is considered for relapsed multiple myeloma (RMM) patients showing prolonged response after a first ASCT. However, given breakthrough treatments like anti-CD38 and immunotherapy, its role remains debated. We conducted a real-life study in 10 French centers (1996–2017) involving 267 RMM patients receiving ASCT2. The median age was 61 years, with 49% females. Most patients received melphalan 200 mg/m² before ASCT2, with low early mortality (1%). Very good partial response or better (VGPR+) rate post ASCT2 was 78%. Post ASCT2, 48% received consolidation therapy and 40% maintenance therapy. Median event-free survival (EFS) after ASCT2 was 2.6 years (95% confidence interval [CI]: 2.3–2.8), and 2-year EFS estimate was 63% (95% CI: 57–70). Median overall survival (OS) was 8.1 years (95% CI: 5.9–NA), and 2-year OS estimate was 92% (95% CI: 88–95). Multivariate analysis revealed that VGPR+ status and maintenance therapy post ASCT2 were associated with better EFS (hazard ratio [HR]: 0.6; 95% CI: 0.3–0.9, p = 0.012 and HR: 0.4; 95% CI: 0.3–0.6, p < 0.001, respectively) and OS (HR: 0.4; 95% CI: 0.2–0.9, p = 0.017 and HR: 0.2; 95% CI: 0.1–0.4, p < 0.001, respectively), while male sex correlated with poorer outcomes for EFS (HR: 2.5; 95% CI: 1.7–3.7, p < 0.001) and OS (HR: 2.7; 95% CI: 1.4–4.9, p = 0.002). Overall, ASCT2 appeared efficient with low toxicity in RMM. Maintenance therapy was associated with extended EFS and OS, particularly in patients with VGPR+ status post ASCT2. These findings underscore ASCT2's potential in RMM when coupled with maintenance therapy in selected patients.

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来源期刊
HemaSphere
HemaSphere Medicine-Hematology
CiteScore
6.10
自引率
4.50%
发文量
2776
审稿时长
7 weeks
期刊介绍: HemaSphere, as a publication, is dedicated to disseminating the outcomes of profoundly pertinent basic, translational, and clinical research endeavors within the field of hematology. The journal actively seeks robust studies that unveil novel discoveries with significant ramifications for hematology. In addition to original research, HemaSphere features review articles and guideline articles that furnish lucid synopses and discussions of emerging developments, along with recommendations for patient care. Positioned as the foremost resource in hematology, HemaSphere augments its offerings with specialized sections like HemaTopics and HemaPolicy. These segments engender insightful dialogues covering a spectrum of hematology-related topics, including digestible summaries of pivotal articles, updates on new therapies, deliberations on European policy matters, and other noteworthy news items within the field. Steering the course of HemaSphere are Editor in Chief Jan Cools and Deputy Editor in Chief Claire Harrison, alongside the guidance of an esteemed Editorial Board comprising international luminaries in both research and clinical realms, each representing diverse areas of hematologic expertise.
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