文章：

自体造血干细胞移植对多发性骨髓瘤患者发生第二原发恶性肿瘤的影响

Effect of autologous hematopoietic stem cell transplant on the development of second primary malignancies in multiple myeloma patients

原文发布日期：2021-01-07

DOI: 10.1038/s41408-020-00400-4

类型: Article

开放获取: 是

英文摘要：

Autologous stem cell transplant (aHSCT) is associated with improved survival for multiple myeloma (MM) patients but may be associated with second primary malignancy (SPM) development. Using the California Cancer Registry linked to statewide hospitalization data, we determined the cumulative incidence (CMI) of SPMs more than 1 year after MM diagnosis, accounting for the competing risk of death. AHSCT recipients were matched 1:2 to non-aHSCT patients. Adjusted hazard ratios (aHR) were estimated using the Fine and Gray method. Among 16,331 patients, 933 (5.7%) developed a SPM more than 1 year after diagnosis. The 10-year CMI of developing any SPM was 6.6%, 5.7% for solid tumor SPM and 0.9% for hematologic malignancies. The 10-year CMI of developing any SPM was similar among aHSCT [9.1% (7.7–10.7%)] and non-aHSCT [7.5% (6.5–8.6%)] (P = 0.26) recipients and there was no difference in solid-tumor SPMs (P = 0.98). The 10-year CMI of hematologic SPMs was higher among aHSCT recipients [2.1% (1.4–2.9%) vs. 0.8% (0.5–1.2%); P = 0.005], corresponding to a 1.3% absolute increase and an aHR of 1.51 (1.01–2.27). Ten-year myeloma-specific and non-cancer mortality rates were 59% (58.2–60.0%) and 18.1% (17.4–18.8%), respectively. Although aHSCT was associated with a small increase in hematologic SPMs, mortality was driven by MM and non-cancer causes.
 

摘要翻译： 

自体造血干细胞移植(aHSCT)可提高多发性骨髓瘤(MM)患者的生存率，但可能增加第二原发恶性肿瘤(SPM)的发生风险。我们利用加州癌症登记库与全州住院数据关联系统，在考虑死亡竞争风险的情况下，评估了MM确诊1年后SPM的累积发生率。研究将aHSCT受者与非aHSCT患者按1:2比例进行匹配，并采用Fine和Gray方法计算校正风险比(aHR)。在16,331例患者中，933例(5.7%)在确诊1年后发生SPM。任何类型SPM的10年累积发生率为6.6%，其中实体肿瘤为5.7%，血液系统恶性肿瘤为0.9%。aHSCT组[9.1%(7.7–10.7%)]与非aHSCT组[7.5%(6.5–8.6%)]的任何类型SPM 10年累积发生率无显著差异(P=0.26)，实体肿瘤SPM发生率亦无差异(P=0.98)。但aHSCT组血液系统SPM的10年累积发生率更高[2.1%(1.4–2.9%)对比0.8%(0.5–1.2%)；P=0.005]，绝对风险增加1.3%，校正风险比aHR为1.51(1.01–2.27)。10年骨髓瘤特异性死亡率与非癌症死亡率分别为59%(58.2–60.0%)和18.1%(17.4–18.8%)。尽管aHSCT与血液系统SPM的轻度增加相关，但患者死亡主要归因于骨髓瘤本身及非癌症因素。

原文链接：

Effect of autologous hematopoietic stem cell transplant on the development of second primary malignancies in multiple myeloma patients