Survival Analysis Of Intravenous Melphalan Combined With Autologous Peripheral Blood Stem Cell Transplantation In The Treatment Of Multiple Myeloma

Objective:To retrospectively analyze the progression-free survival(PFS)of patients with multiple myeloma(multiplemyeloma,MM)treated with high-dose intravenous melphalan(high-dosemelphalan(HDM))combined with peripheral blood autologous stem cell transplantation (autologoushematopoieticstemcelltransplantation,auto-HSCT)(HDM-HSCT).Methods:The 44 patients with MM who received HDM-HSCT in the Hematology Center of the first affiliated Hospital of Xinjiang Medical University from September 2019 to December 2023 were analyzed retrospectively.The data of 44 patients with multiple myeloma newly diagnosed in the department of hematology in our hospital were collected,and their PFS and prognostic factors were analyzed.Results: Revascularization was successfully completed in all patients with multiple myeloma who received HDM-HSCT,and there was no transplant-related death.By the end of follow-up(2023.3.31),the total response rate(ORR,s CR+CR+VGPR+PR)of 44 consecutive patients with multiple myeloma after induction chemotherapy was 100%(44 /44).The CR rate of 44 patients increased from 43.1%(19/ 44)after induction chemotherapy to 70.5%(31/ 44)after HDM-HSCT.The rate of≥VGPR increased from 68.0%(34/ 44)after induction chemotherapy to 91.0%(40/ 44)after HDM-HSCT.The remission rate of MM after hematopoietic stem cell transplantation was significantly higher than that of control group(P<0.05).By the end of follow-up,the median progression-free survival(PFS)of 44 consecutive cases of multiple myeloma was 18.5 months,the median overall survival time(OS)was 21 months,and the 3-year PFS was expected to be 72.0%(95%CI,56.71%-87.29%).The expected 3-year OS is 87.4%(95%CI,74.66%～100.14%).The results of univariate analysis showed that there was a significant difference in PFS between MRDnegative and MRD-positive patients after intravenous HDMASCT(P=0.0 08).Among the 44 MM patients,the 3-year PFS of the standard risk patients was 72.2%(95%CI,53.00%-91.40%),and the 3-year expected PFS of the high-risk patients was71.4%(95%CI,47.70%-95.11%).The difference was not statistically significant(P=0.513).Conclusion: In the era of new drugs,intravenous melphalan combined with autologous hematopoietic stem cell transplantation can further improve the efficacy of MM.PFS in patients with persistent negative MRD after transplantation was significantly higher than that in patients with positive MRD.