Second Autologous Stem Cell Transplant As Salvage Therapy For Multiple Myeloma
Notice bibliographique
Résumé
Abstract Introduction Therapeutic options for patients with multiple myeloma whose disease has relapsed after a prior autologous SCT include novel agents, traditional chemotherapy or a second transplant, with no clear standard of care. Limited data are available regarding the value of salvage therapy with a second autologous SCT in patients who relapse after the first one, and the factors that determine the outcome of the second SCT. We retrospectively reviewed our experience at Saskatoon Cancer Center with salvage autologous SCT for relapsed multiple myeloma. Methods Thirty three patients had received a salvage auto-SCT at our institution between February 2000 to February 2012. Median age at second SCT was 60 years (range; 46-71), Median time to relapse after the first SCT was 32 months (range; 3-80). Median interval between the first and second transplant was 34 months (range; 4-85). Re-induction therapy prior to second transplant contained combination with novel therapies (Bortezomib , lenalidomide or Thalidomide) in Thirteen patients ( 40 %) and the rest received conventional combination chemotherapies. Median line of therapies before the second SCT was 1 (range 0-3) with 23 patients (70%) received less than 2 lines and 30% received more than 2 lines. Results Responses to second autologous SCT at day 100 showed CR in 21%, VGPR 30 %, PR 42% with ORR 93 %. Non relapse mortality at day 100 after second transplant was 3 % (no= 1) With a median follow up time of 24 months (range 1-99) from the salvage SCT, the median PFS was 27 months (range 1-89) and the median overall survival (OS) was 36 months ( range 1-99) Eleven patients had TTP inversion (PFS longer after the second transplant) with a median increase of 18 months , of note only two of them received novel agents for salvage, but 70 % required less than two lines prior to salvage SCT. In univariate analysis, patients who had received < 2 lines of therapy prior to salvage SCT (23/33) had significantly higher median TTP of 31 and OS of 52 months, compared to 19 and 33 months for patients who had received ≥2 lines of therapy (10/33). (P = 0.04) Patients who had relapsed more than 2 years post 1st SCT (18/33) had a significantly higher median TTP and OS of 27 and 39 months respectively compared to 22 and 24 months patients who had relapsed less or equal to 2 years (15/33) (P= 0.04) In multivariate analysis, only response to salvage SCT > PR had an impact on TTP and OS; however it was not statistically significant. Conclusion Second salvage auto-SCT generally is safe and effective in patients with relapsed multiple myeloma. Patients with ≥2 prior lines of therapy and a TTP after initial transplant of ≤24 months are unlikely to benefit significantly. Salvage auto-SCT should therefore be considered for appropriate patients with relapsed multiple myeloma. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».