Analysis Of The Efficacy And Prognostic Factors Of 67 Patients With Multiple Myeloma After Undergoing Autologous Peripheral Hematopoietic Stem Cell Transplantation

Objective:To explore the efficacy and prognostic factors of autologous stem cell transplantation(ASCT)for multiple myeloma(MM)patients.Methods:67 patients with MM and received induction treatment followed by ASCT at the First Affiliated Hospital of Zhejiang University from July,2009 to October 2017 were enrolled.With the follow up to March 1,2018,the overall survival(OS),progression free survival(PFS)and prognostic factors,including R-ISS stage,extramedullary lesions,response and conditioning regimen were analyzed.Results:(1)67 patients had completed autologous stem cell transplantation.The median number of infused mononuclear cells(MNC)was 8.35 x 108/kg,and the median number of CD34+ cells was 3.8 × 106/kg.65 patients have received hematopoietic reconstitution,while 1 patient died due to transplant-related causes,1 patient failed in platelet recovery and reinfused autologous stem cell after 7 months.The median time to neutrophil engraftment was 12 days and platelet engraftment was 13 days.(2)After ASCT,all(100%)patients achieved partial response(PR),and 59.1%patients achieved complete remission(CR).With median follow-up of 28(5-105)months,31 patients relapsed after transplantation and 16 patients died.One patient died of the second tumor,the remaining patients died of disease progression,and 3 patients were lost to follow-up.The median PFS was 55.6 months,the median OS was not achieved,and the 5-year OS rate was 67.1%.The patients were reclassified at diagnosis according to the Revised International Classification System(R-ISS),11 cases(16.4%)had stage ?,23 cases(34.3%)had stage ?,8 cases(11.9%)had stage ?,with median PFS 85.4?51.9 and 20.9 months,for R-ISS ? and ?,and ?,respectively,(P=0.047).There was a significant difference in median OS(not yet reached,60.9 and 22.9 months for R-ISS ? and ?,and ?,respectively,P=0.007)among the three stages of R-ISS.We also found that patients belonging to R-ISS ? and having high-risk chromosomal abnormalities(CA)had a significant shorter median PFS and OS than those with R-ISS? without CA.Both the ISS and LDH influenced the PFS and the OS.However,the ISS was unable to discriminate patients in stages ISS ? and ISS ? or in stages ISS ? and ISS? regarding PFS.MRD negative by flow cytometry(defined as<10-4)in post-ASCT BM cases(n=15)showed a better PFS(95.07 months,P=0.05).The pre-transplant efficacy,pretreatment regimen,post-transplant efficacy,and maintenance treatment subgroup analysis showed that there was no significant difference in median OS and PFS between groups.Cox analysis showed that R-ISS was independent prognostic factors for PFS and OS.Conclusion:Induction therapy followed by ASCT is a safe strategy for MM patients,and also significantly improve their outcome.The R-ISS and low level MRD are reliable prognostic tools for estimating survival in transplant myeloma patients.