Improved survival in multiple Myeloma patients undergoing autologous stem cell transplantation is entirely in the standard cytogenetic risk groups.
Adult
Aged
Chromosome Aberrations
Combined Modality Therapy
Cytogenetic Analysis
Female
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
In Situ Hybridization, Fluorescence
Male
Middle Aged
Multiple Myeloma
/ diagnosis
Prognosis
Retreatment
Survival Analysis
Transplantation, Autologous
Treatment Outcome
high-risk cytogenetics
multiple myeloma
survival
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
26
12
2020
revised:
15
01
2021
accepted:
18
01
2021
pubmed:
21
1
2021
medline:
29
7
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
Novel drugs and drug combinations have improved outcomes for multiple myeloma patients. However, subgroups of patients still have a poor progression-free survival (PFS) and overall survival (OS). In an attempt to identify how the novel drugs affect the outcome in standard-risk and high-risk patients, respectively, we have investigated 715 multiple myeloma (MM) patients who have undergone high dose treatment followed by autologous stem cell transplantation at our center during 1995 - 2020. Outcomes during three time periods, 1995-1999 (period I), 2000-2009 (period II), and 2010-2020 (period III), were compared separately for standard-risk and high-risk patients. Risk stratification was based on chromosome analysis for periods II and III. The whole cohort of patients showed significantly improved OS with time during the three periods being at a median of 5.8, 7.0, and 10.0 years, respectively. There is also a weak tendency for improved PFS, that is, a median of 2.4, 2.6, and 2.9 years, respectively, during the same periods. However, the separate analysis of standard-risk and high-risk patients showed that the overall improvement with time was due to improved standard-risk patients (median OS 8.4 years for the period I and not reached for period II and III). In contrast, no significant improvement was seen in high-risk patients. For patients with del17p, PFS was even worse during period III as compared to period II (median 1.6 vs 3.2 years respectively). Our results show that the dramatic improvement in outcome for MM patients during the last 20 years only applies for standard-risk patients, while high-risk MM patients still are doing poorly, indicating that the novel drugs developed during this time are preferentially effective in standard-risk patients. New treatment modalities like CAR-T cells, CAR-NK cells, and/or bispecific antibodies should be tried in clinical studies early in the course of the disease, especially in patients with high-risk cytogenetics.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
546-554Subventions
Organisme : Cancerfonden
Informations de copyright
© 2021 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.
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