Autologous stem cell transplant (ASCT) remains an important option for eligible multiple myeloma (MM) patients as part of initial therapy. Using the Canadian Myeloma Research Group (CMRG) national database, we examined the details and outcomes of ASCT performed as first-line therapy in eligible Canadian MM patients between 2007 to 2021. We included 3821 patients with 72% receiving CyBorD induction and 2061 patients receiving maintenance, consisting of lenalidomide +/- steroids in 78.3%. The median PFS and OS for patients given a single ASCT were 35.4 and 126 months. Those receiving a second induction regimen had significantly inferior outcomes, although when maintenance was used, results were comparable regardless of the number of induction regimens administered (median PFS 55.3 vs 51.1 months [p = 0.11]; median OS 158.6 vs not yet reached [p = 0.13]). Consolidation patients had a longer median PFS (55.3 vs 34.4 months [p = 0.001]), but no significant gain in median OS (p = 0.065). Patients who received lenalidomide-based maintenance experienced a median PFS of 53.7 months and OS of 159 months. In the multivariable analysis, use of any type of maintenance therapy vs no maintenance was associated with a lower risk of progression (HR 0.52 (95% CI 0.47-0.57)) and death (HR 0.58 (95% CI 0.51-0.67)). This real-world study demonstrates that, overall, first-line treatment sequence in transplant-eligible patients produces a median OS of ≥10 years. It also highlights the contribution of post-ASCT maintenance, particularly lenalidomide given until progression.
自体干细胞移植（ASCT）作为初始治疗的一部分，仍是适合多发性骨髓瘤（MM）患者的重要选择。通过加拿大骨髓瘤研究组（CMRG）国家数据库，我们分析了2007年至2021年间适合接受ASCT的加拿大MM患者将ASCT作为一线治疗的细节与结局。研究共纳入3821例患者，其中72%接受环磷酰胺、硼替佐米和地塞米松（CyBorD）诱导治疗，2061例患者接受维持治疗，其中78.3%采用来那度胺联合或不联合类固醇方案。接受单次ASCT患者的中位无进展生存期（PFS）和总生存期（OS）分别为35.4个月和126个月。接受二次诱导治疗方案的患者预后显著较差，但当采用维持治疗时，无论诱导方案数量如何，其结果具有可比性（中位PFS 55.3个月 vs 51.1个月 [p=0.11]；中位OS 158.6个月 vs 未达到 [p=0.13]）。接受巩固治疗的患者中位PFS更长（55.3个月 vs 34.4个月 [p=0.001]），但中位OS无显著改善（p=0.065）。接受以来那度胺为基础的维持治疗患者中位PFS为53.7个月，OS为159个月。在多变量分析中，采用任何维持治疗相较于无维持治疗与更低的疾病进展风险（风险比0.52，95%置信区间0.47-0.57）和死亡风险（风险比0.58，95%置信区间0.51-0.67）相关。这项真实世界研究表明，总体上适合移植患者的一线治疗序贯方案可产生≥10年的中位OS，同时凸显了ASCT后维持治疗（特别是持续使用至疾病进展的来那度胺）的重要贡献。
肿瘤(癌症)患者之家