Abstract
Though a large number of studies have confirmed that large dose chemotherapy combined with autologous transplantation can improve the OS and PFS in patients with multiple myeloma, the suitable time for transplantation is not yet conclusive. The impact of treatment depth on survival and the essentiality of maintenance therapy after autologous transplantation because of the maintenance-related side effects is also inconclusive.
To evaluate the efficacy of autologous hematopoietic stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM), the effects of transplantation timing, depth of treatment and maintenance therapy on survival in patients with multiple myeloma (MM).
The data of 111 patients with multiple myeloma who received autologous hematopoietic stem cell transplantation (ASCT) from April 30, 2004 to June 30, 2015 were retrospectively analyzed. The median follow-up period was 31 (6-139) months.
109 of the 111 patients successfully underwent hematopoietic reconstruction,2 patients died of transplantation-related mortality. The overall response rates(ORR)rate increased from 82.9%(92/111)at pre-ASCT to 91.9%(102/111)at post-ASCT. The median progress free survival(PFS)was 50 months. The median overall survival(OS)was not reached. The median PFS and median OS in the sequential transplantation group were significantly better than those in the non sequential transplantation group (86 months vs33 months, P=0.001,not reached vs 43 months, P=0.000).The median PFS of patients achieving a nCR at pre-ASCT was longer than those not achieving a nCR group (62 months vs 34 months, P=0.023).OS showed any significance(not reached vs 47 months, P=0.094).The median PFS of patients achieving a nCR at post-ASCT was longer than those not achieving a nCR group (54 months vs 26 months, P=0.004).OS showed any significance(not reached vs 53 months, P=0.128).Regarding maintenance therapy:the group of patients achieving post-ASCT nCR:The median PFS of patients with maintenance therapy was longer than those without maintenance treatment(86 months vs 33 months, P=0.009).The median OS in maintenance therapy group was not reached,the median OS in the maintenance free treatment group was 47 months (P=0.004).The group of patients achieving less than nCR at post-ASCT:In the maintenance group, the median PFS was 26 months,the median PFS for maintenance free treatment group was 9 months (P=0.518).The median OS of patients with maintenance therapy was longer than those without maintenance treatment(53 months vs 28 months, P=0.011).
Autologous transplantation after induction chemotherapy, with maintenance therapy is the preferred treatment for patients with MM.The depth of treatment has a great influence on the survival time of patients,Patients with nCR at any time during the therapy (pre-ASCT,post-ASCT) had longer OS.Maintenance therapy is associated with an extended OS, no matter whether a nCR is reached or not at post-ASCT.
Disclosures
No relevant conflicts of interest to declare.
Case Report: Bortezomib Plus CDOP Followed by Sequential Autologous Hematopoietic Stem Cell Transplantation and Lenalidomide-Based Maintenance Therapy in Plasmablastic Lymphoma
