Abstract:
Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in young patients with high-risk multiple myeloma (HRMM) and analyzed the factors affecting patient prognosis. Methods: In this retrospective study, we analyzed the clinical data of 14 patients with HRMM with cytogenetic abnormalities or high-risk biological factors who underwent allo-HSCT at the Hematopoietic Stem Cell Transplantation Center of the Institute of Hematology & Blood Diseases Hospital between November 2016 and November 2022. Results: There were seven males and seven females included in the study, with a median age of 39.5 (31-50) years at the time of allo-HSCT. The median number of treatment lines before transplantation was 2 (1-6) . Before allo-HSCT, 42.9% (6/14) of the patients did not achieve complete remission, while 35.7% (5/14) of the patients achieved measurable residual disease positivity. After transplantation, all patients were evaluated for their treatment response, and the overall response rate was 100% (14/14) . All 14 patients successfully underwent allo-HSCT, with median engraftment times for neutrophils and platelets of 11 (10-14) days and 13 (9-103) days, respectively. Acute grade Ⅱ-Ⅳ graft-versus-host disease (GVHD) occurred in five patients (35.7%) , and two patients (14.3%) developed moderate-to-severe chronic GVHD. The median follow-up time after allo-HSCT was 18.93 (4.10-72.53) months, with an expected 2-year transplant-related mortality rate of 7.1% (95% CI 0%-21.1%) and an expected 2-year overall survival rate of 92.9% (95% CI 80.3%-100.0%) . Moreover, the expected 1-year and 2-year progression-free survival rates were 92.9% (95% CI 80.3%-100.0%) and 66.0% (95% CI 39.4%-100.0%) , respectively, and the 2-year cumulative incidence of relapse was 28.9% (95% CI 0%-56.7%) . Upfront allo-HSCT following complete remission after induced therapy and the presence of chronic GVHD might be favorable prognostic factors. Conclusion: allo-HSCT is an effective treatment for improving the prognosis of young patients with HRMM.
目的: 观察异基因造血干细胞移植(allo-HSCT)对年轻(≤50岁)高危多发性骨髓瘤(HRMM)患者的疗效。 方法: 纳入2016年11月至2022年11月期间于中国医学科学院血液病医院造血干细胞移植中心接受allo-HSCT的14例具有高危细胞遗传学改变或高危疾病生物学因素的年轻(≤50岁)HRMM患者,对其临床资料进行回顾性分析。 结果: 14例患者中,男7例,女7例,移植时中位年龄为39.5(31~50)岁。患者移植前中位治疗线数为2(1~6)线,移植前6例患者未达完全缓解(CR),5例患者微小残留病(MRD)阳性。14例患者均获得造血重建,中性粒细胞、血小板中位植入时间分别为11(10~14)d、13(9~103)d。5例患者发生Ⅱ~Ⅳ度急性移植物抗宿主病(GVHD),2例患者发生中重度慢性GVHD。移植后3个月疗效评估,所有患者均为严格意义的完全缓解(sCR)。移植后中位随访时间为18.9(4.1~72.5)个月,移植后2年移植相关死亡率为7.1%(95% CI 0%~21.1%),总生存率为92.9%(95% CI 80.3%~100.0%);移植后1、2年无进展生存率分别为92.9%(95%CI 80.3%~100.0%)、66.0%(95%CI 39.4%~100.0%),2年累积复发率为28.9%(95%CI 0%~56.7%)。 结论: 年轻HRMM患者在诱导治疗后桥接allo-HSCT可进一步提高疗效。.