文章：

新药时代下，自体造血干细胞移植前通过检测循环浆细胞对骨髓瘤进行风险分层

Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era

原文发布日期：2016-12-16

DOI: 10.1038/bcj.2016.117

类型: Original Article

开放获取: 是

英文摘要：

The impact of circulating plasma cells (CPCs) prior to autologous stem cell transplantation (ASCT) for multiple myeloma has not been defined in the novel agent era. We evaluated the impact of pre-transplant CPCs, detected by six-color flow cytometry in patients undergoing early ASCT on post-transplant response, progression-free survival (PFS) and overall survival (OS). CPCs were detected in 162 out of 840 (19.3%) patients, with the median number of CPCs being 58 per 150 000 events. Ninety-nine percent of patients had received proteasome inhibitor and/or immunomodulator-based induction. The incidence of post-transplant stringent complete response (sCR) in the subgroups with and without CPCs was 15% and 38%, respectively, (P<0.001). The median PFS in the subgroups with and without CPCs was 15.1 (95% confidence interval (CI), 12.5–17.8) and 29.6 months (95% CI, 26.2–32.8), respectively, and the median OS was 41.0 months (95% CI, 32.6–58.2) and not reached (NR) (95% CI, 99.1-NR), respectively, (P<0.001 for both). On multivariate analysis for OS, factors independently predictive of mortality were the presence of CPCs (hazard ratio (HR) 2.5; 95% CI, 1.8–3.6; P<0.001) and sCR post transplant (HR 0.4; 95% CI, 0.2–0.6; P<0.001). Presence of CPCs prior to transplant has a high prognostic impact and should be prospectively validated in clinical trials.

摘要翻译： 

在新药时代，自体干细胞移植前循环浆细胞对多发性骨髓瘤的影响尚未明确。我们通过六色流式细胞术检测早期接受自体干细胞移植患者移植前循环浆细胞，并评估其对移植后缓解、无进展生存期和总生存期的影响。840例患者中162例（19.3%）检出循环浆细胞，中位循环浆细胞数为每150,000个事件中58个。99%的患者曾接受蛋白酶体抑制剂和/或免疫调节剂为基础的诱导治疗。移植后严格完全缓解率在循环浆细胞阳性组和阴性组分别为15%和38%（P<0.001）。两组中位无进展生存期分别为15.1个月（95%置信区间12.5-17.8）和29.6个月（95%置信区间26.2-32.8），中位总生存期分别为41.0个月（95%置信区间32.6-58.2）和未达到（95%置信区间99.1-未达到）（均P<0.001）。多因素分析显示，移植前存在循环浆细胞（风险比2.5；95%置信区间1.8-3.6；P<0.001）与未达到移植后严格完全缓解（风险比0.4；95%置信区间0.2-0.6；P<0.001）是总生存期的独立预测因素。移植前循环浆细胞存在具有重要预后价值，需在前瞻性临床试验中进一步验证。

原文链接：

Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era