Bone Marrow Transplantation ( IF 4.5 ) Pub Date : 2020-02-17 , DOI: 10.1038/s41409-020-0829-1
Roni Shouval 1, 2 , Omer Teper 1 , Joshua A Fein 1, 3 , Ivetta Danylesko 1 , Noga Shem Tov 1 , Ronit Yerushalmi 1 , Abraham Avigdor 1 , Elena Vasilev 1 , Hila Magen 1 , Arnon Nagler 1 , Avichai Shimoni 1
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Allogeneic hematopoietic stem cell transplantation (allo-SCT) may offer a cure for selected patients with multiple myeloma (MM). Effective prognostic markers to guide patient selection are warranted. We retrospectively studied a cohort of 100 relapsed refractory MM patients who underwent allo-SCT. With a median follow-up of 12.2 years, median overall survival (OS) and progression-free survival (LFS) were 9.2 months and 5.6 months, respectively. 5-years OS and PFS were was 18.0% and 16.8%. The cumulative incidence of 5-years relapse was 45.9% and non-relapse mortality (NRM) 36.0%. In a multivariable Cox model, decreasing albumin, increasing lactate dehydrogenase (LDH), advanced disease, and mismatched donors were predictive of both reduced OS and PFS. The probability of 5-years OS was higher in patients with LDH below vs. the upper limit of normal (22% vs. 5%, p = 0.004). In the multivariable analysis, the hazard of NRM was increased with low albumin, mismatched donor type, and declining estimated glomerular filtration rate (eGFR). Patients with a low eGFR had a 5-year NRM incidence of 31% vs. 56% in patients with higher levels (p = 0.02). Graft-versus-host disease was not associated with improved outcomes. In conclusion, LDH, renal function, and albumin are highly informative of outcomes in MM patients treated with allo-SCT.
中文翻译:
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LDH和肾功能是多发性骨髓瘤患者异基因造血干细胞移植长期预后的预后因素
同种异体造血干细胞移植 (allo-SCT) 可以治愈选定的多发性骨髓瘤 (MM) 患者。有必要使用有效的预后标志物来指导患者的选择。我们回顾性研究了 100 名接受 allo-SCT 的复发难治性 MM 患者的队列。中位随访时间为 12.2 年,中位总生存期 (OS) 和无进展生存期 (LFS) 分别为 9.2 个月和 5.6 个月。5 年 OS 和 PFS 分别为 18.0% 和 16.8%。5 年复发的累积发生率为 45.9%,非复发死亡率 (NRM) 为 36.0%。在多变量 Cox 模型中,白蛋白减少、乳酸脱氢酶 (LDH) 增加、晚期疾病和不匹配的供体可预测 OS 和 PFS 降低。LDH 低于 5 年 OS 的概率高于 5 年 OS。p = 0.004)。在多变量分析中,NRM 的风险随着白蛋白低、供体类型不匹配和估计肾小球滤过率 (eGFR) 下降而增加。eGFR 较低的患者 5 年 NRM 发生率为 31%,而较高水平的患者为 56%(p = 0.02)。移植物抗宿主病与改善结果无关。总之,LDH、肾功能和白蛋白对接受 allo-SCT 治疗的 MM 患者的结果具有高度信息性。