文章：

新诊断适合移植的多发性骨髓瘤患者长期生存的临床预测因素——国际骨髓瘤工作组（IMWG）研究项目

Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma — an IMWG Research Project

原文发布日期：2018-11-23

DOI: 10.1038/s41408-018-0155-7

类型: Article

开放获取: 是

英文摘要：

Purpose: multiple myeloma is considered an incurable hematologic cancer but a subset of patients can achieve long-term remissions and survival. The present study examines the clinical features of long-term survival as it correlates to depth of disease response. Patients & Methods: this was a multi-institutional, international, retrospective analysis of high-dose melphalan-autologous stem cell transplant (HDM-ASCT) eligible MM patients included in clinical trials. Clinical variable and survival data were collected from 7291 MM patients from Czech Republic, France, Germany, Italy, Korea, Spain, the Nordic Myeloma Study Group and the United States. Kaplan–Meier curves were used to assess progression-free survival (PFS) and overall survival (OS). Relative survival (RS) and statistical cure fractions (CF) were computed for all patients with available data. Results: achieving CR at 1 year was associated with superior PFS (median PFS 3.3 years vs. 2.6 years, p < 0.0001) as well as OS (median OS 8.5 years vs. 6.3 years, p < 0.0001). Clinical variables at diagnosis associated with 5-year survival and 10-year survival were compared with those associated with 2-year death. In multivariate analysis, age over 65 years (OR 1.87, p = 0.002), IgA Isotype (OR 1.53, p = 0.004), low albumin < 3.5 g/dL (OR = 1.36, p = 0.023), elevated beta 2 microglobulin ≥ 3.5 mg/dL (OR 1.86, p < 0.001), serum creatinine levels ≥ 2 mg/dL (OR 1.77, p = 0.005), hemoglobin levels < 10 g/dL (OR 1.55, p = 0.003), and platelet count < 150k/μL (OR 2.26, p < 0.001) appeared to be negatively associated with 10-year survival. The relative survival for the cohort was ~0.9, and the statistical cure fraction was 14.3%. Conclusions: these data identify CR as an important predictor of long-term survival for HDM-ASCT eligible MM patients. They also identify clinical variables reflective of higher disease burden as poor prognostic markers for long-term survival.

摘要翻译： 

目的：多发性骨髓瘤虽被视为不可治愈的血液系统恶性肿瘤，但部分患者可获得长期缓解与生存。本研究探讨与长期生存相关的临床特征及其与疾病缓解深度的关联。患者与方法：这是一项多中心、国际性、回顾性分析，纳入符合大剂量马法兰-自体干细胞移植条件的多发性骨髓瘤患者，所有患者均来自临床试验数据集。研究收集了来自捷克、法国、德国、意大利、韩国、西班牙、北欧骨髓瘤研究组及美国的7291例患者临床变量与生存数据。采用Kaplan-Meier曲线评估无进展生存期和总生存期，对全部可用数据计算相对生存率及统计学治愈比例。结果：治疗1年内达到完全缓解与更优的无进展生存期（中位PFS 3.3年 vs 2.6年, p < 0.0001）和总生存期（中位OS 8.5年 vs 6.3年, p < 0.0001）显著相关。比较诊断时与5年生存、10年生存相关的临床变量发现，年龄大于65岁（OR=1.87, p=0.002）、IgA型（OR=1.53, p=0.004）、低白蛋白<3.5g/dL（OR=1.36, p=0.023）、β2微球蛋白≥3.5mg/dL（OR=1.86, p<0.001）、血肌酐≥2mg/dL（OR=1.77, p=0.005）、血红蛋白<10g/dL（OR=1.55, p=0.003）及血小板<150k/μL（OR=2.26, p<0.001）与10年生存呈负相关。该队列相对生存率约0.9，统计学治愈比例为14.3%。结论：本研究证实完全缓解是符合HDM-ASCT条件多发性骨髓瘤患者长期生存的重要预测指标，同时明确反映较高肿瘤负荷的临床变量是长期生存的不良预后标志。

原文链接：

Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma — an IMWG Research Project