Abstract：
UNASSIGNED: High-risk multiple myeloma (HRMM) is associated with poor survival, despite many advances in antimyeloma strategies. Autologous followed by allogeneic stem cell transplantation (auto-allo-SCT) has yielded controversial results compared to tandem autologous stem cell transplantation (auto-SCT) in patients with HRMM. We conducted this meta-analysis to compare the efficacy and safety of auto-allo-SCT and tandem-auto-SCT in patients with HRMM.
UNASSIGNED: Embase, Cochrane Library, and PubMed databases were searched until March 2023. Prospective or retrospective studies comparing the effects of auto-allo-SCT and tandem-auto-SCT were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time-to-event outcomes, and odds ratios (ORs) and 95%CIs for dichotomous outcomes were pooled using random-effects models.
UNASSIGNED: Three studies involving 491 patients were included. Despite auto-allo-SCT seemed to be associated with improvements in progression-free survival (PFS) (HR [95%CI], 0.71 [0.51-1.00]) and complete response (CR) (OR [95%CI], 3.16 [1.67-5.99]), and reduced relapse/progression rates (47% vs. 55%) in comparison with tandem-auto-SCT, no marked improvement in overall survival (OS). In comparison to tandem-auto-SCT, patients assigned to auto-allo-SCT exhibited a higher risk of transplant-related mortality (TRM) (11.9% vs. 4.1%) and non-relapse mortality (NRM) (12.3% vs. 3.1%).
UNASSIGNED: Auto-allo-SCT seemed to be associated with improvements in PFS and CR when compared to tandem-auto-SCT in patients with HRMM, but it did not lead to a significant improvement in OS. Furthermore, patients in the auto-allo-SCT group were at a higher risk of developing TRM and NRM. Auto-allo-SCT transplantation should not be routinely incorporated into HRMM therapy but rather should be considered investigational.
UNASSIGNED: Embase, Cochrane Library, and PubMed databases were searched until March 2023. Prospective or retrospective studies comparing the effects of auto-allo-SCT and tandem-auto-SCT were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time-to-event outcomes, and odds ratios (ORs) and 95%CIs for dichotomous outcomes were pooled using random-effects models.
UNASSIGNED: Three studies involving 491 patients were included. Despite auto-allo-SCT seemed to be associated with improvements in progression-free survival (PFS) (HR [95%CI], 0.71 [0.51-1.00]) and complete response (CR) (OR [95%CI], 3.16 [1.67-5.99]), and reduced relapse/progression rates (47% vs. 55%) in comparison with tandem-auto-SCT, no marked improvement in overall survival (OS). In comparison to tandem-auto-SCT, patients assigned to auto-allo-SCT exhibited a higher risk of transplant-related mortality (TRM) (11.9% vs. 4.1%) and non-relapse mortality (NRM) (12.3% vs. 3.1%).
UNASSIGNED: Auto-allo-SCT seemed to be associated with improvements in PFS and CR when compared to tandem-auto-SCT in patients with HRMM, but it did not lead to a significant improvement in OS. Furthermore, patients in the auto-allo-SCT group were at a higher risk of developing TRM and NRM. Auto-allo-SCT transplantation should not be routinely incorporated into HRMM therapy but rather should be considered investigational.
摘要：
■高危多发性骨髓瘤（HRMM）与低生存率相关，尽管在抗白血病策略方面取得了许多进展。与HRMM患者的串联自体干细胞移植（auto-allo-SCT）相比，自体干细胞移植（auto-allo-SCT）产生了有争议的结果。我们进行了这项荟萃分析，以比较自allo-SCT和串联自SCT在HRMM患者中的疗效和安全性。
■Embase,科克伦图书馆,和PubMed数据库一直搜索到2023年3月。纳入了比较自动allo-SCT和串联自动SCT效果的前瞻性或回顾性研究。事件发生时间结果的危险比(HR)和95%置信区间(CI)，使用随机效应模型汇总二分结局的比值比(ORs)和95CI。
■纳入了三项涉及491名患者的研究。尽管自动全SCT似乎与无进展生存期（PFS）的改善有关（HR[95CI]，0.71[0.51-1.00])和完全反应(CR)(OR[95CI]，3.16[1.67-5.99]),并降低复发/进展率(47%vs.55%)与串联自动SCT相比，总生存期（OS）无明显改善。与串联自动SCT相比，接受自动allo-SCT的患者表现出更高的移植相关死亡率(TRM)风险(11.9%vs.4.1%）和非复发死亡率（NRM）（12.3%vs.3.1%）。
■在HRMM患者中，与串联自动SCT相比，自动allo-SCT似乎与PFS和CR的改善有关，但它并没有导致操作系统的显着改善。此外，auto-allo-SCT组患者发生TRM和NRM的风险较高.自体同种异体SCT移植不应常规纳入HRMM治疗，而应视为研究性移植。
■Embase,科克伦图书馆,和PubMed数据库一直搜索到2023年3月。纳入了比较自动allo-SCT和串联自动SCT效果的前瞻性或回顾性研究。事件发生时间结果的危险比(HR)和95%置信区间(CI)，使用随机效应模型汇总二分结局的比值比(ORs)和95CI。
■纳入了三项涉及491名患者的研究。尽管自动全SCT似乎与无进展生存期（PFS）的改善有关（HR[95CI]，0.71[0.51-1.00])和完全反应(CR)(OR[95CI]，3.16[1.67-5.99]),并降低复发/进展率(47%vs.55%)与串联自动SCT相比，总生存期（OS）无明显改善。与串联自动SCT相比，接受自动allo-SCT的患者表现出更高的移植相关死亡率(TRM)风险(11.9%vs.4.1%）和非复发死亡率（NRM）（12.3%vs.3.1%）。
■在HRMM患者中，与串联自动SCT相比，自动allo-SCT似乎与PFS和CR的改善有关，但它并没有导致操作系统的显着改善。此外，auto-allo-SCT组患者发生TRM和NRM的风险较高.自体同种异体SCT移植不应常规纳入HRMM治疗，而应视为研究性移植。
