Trends in Outcomes over Three Decades after Upfront Autologous Stem Cell Transplant for Multiple Myeloma at MD Anderson Cancer Center
Notice bibliographique
Résumé
Introduction Remarkable advances have been made in the treatment of multiple myeloma (MM) with the advent of novel therapies and the use of post-transplant maintenance. We report trends in outcomes of MM patients who received upfront autologous hematopoietic stem cell transplantation (autoHCT) at our institution over more than three decades. Methods We conducted a single-center retrospective study of patients with newly diagnosed MM undergoing upfront autoHCT between 1988 to 2021. Patients were grouped by the year of autoHCT: 1988-2000 (n=249), 2001-2005 (n=373), 2006-2010 (n=568), 2011-2015 (n=815) and 2016-2021 (n=1036). High-risk cytogenetic abnormalities were defined as del17p, t(4;14), t(14;16), 1q21 gain or amplification by fluorescence in situ hybridization. Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and group differences were assessed using the log-rank test. Associations between demographic and clinical factors and survival outcomes were evaluated using Cox proportional hazards regression analysis. Results A total of 3041 patients were included in our analysis. Median age at autoHCT increased from 52 years (1988-2000) to 62 years (2016-2021), with only 1% of transplanted patients being ≥ 65 years of age in 1988-2000, compared to 38% in 2016-2021 (p<0.001). The proportion of African-American patients increased from 9% in 1988-2000 to 19% in 2016-2021 (p=0.004). The incidence of high-risk cytogenetics increased from 15% in 1988-2000 to 40% in 2016-2021 (p<0.001). The comorbidity burden, as measured by the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), increased over time, with 17% of patients having HCT-CI>3 in 1988-2000 compared to 28% in 2016-2021 (p<0.001). Induction regimens evolved over time from predominately conventional chemotherapy (39%) in 1988-2000 to immunomodulatory drug (IMiD) and proteasome inhibitor (PI)-based regimens, with 74% receiving an IMiD-PI containing triplet [39% bortezomib, lenalidomide and dexamethasone (VRD) and 35% carfilzomib, lenalidomide and dexamethasone (KRD)] between 2016-2021 (p<0.001). Maintenance therapy was used in >80% from 2011 onwards (Table 1). Response rates prior to autoHCT steadily improved with 4% and 10% patients achieving ≥CR and ≥VGPR between 1988-2000, compared to 19% and 65% between 2016-2021, respectively. At day 100 post-transplant, 24% and 49% patients achieved ≥CR and ≥VGPR between 1988-2000 compared to 41% and 81% between 2016-2021, respectively. At best post-transplant response, 33% and 53% patients achieved ≥CR and ≥VGPR between 1988-2000 compared to 63% and 91% between 2016-2021, respectively. The median PFS in the entire study population was 38.3 months (95% CI 36.4-40.3), improving from 22.3 months between 1988-2000 to 58.6 months between 2016-2021 (hazard ratio [95% CI]: 0.42 [0.36-0.50], p<0.001; Figure 1A). Notably, patients with high-risk cytogenetics also had an improvement in PFS in recent years, with a median PFS of 28.0 months (0.38 [0.26-0.55], p<0.001) and 36.8 months (0.32 [0.22-0.46], p<0.001) in 2011-2015 and 2016-2021, respectively, compared to only 13.7 months in 2001-2005. Patients aged ≥65 years also had an improvement in median PFS from 33.6 months (95% CI 23.1-44.2) between 2001-2005 to 52.8 months (95% CI 40.0-68.5, p<0.001) between 2016-2021. Median OS was 99.4 months (95% CI 94.2-104.0) in the entire study population, steadily improving from 55.1 months to not reached (0.41 [0.33-0.52], p<0.001) in 1988-2000 and 2016-2021, respectively (Figure 1B). Similarly, in those with high-risk cytogenetics, OS improved with a median OS of 32.9 months in 2001-2005 compared to 66.5 months (0.39 [0.26-0.61], p<0.001) in 2016-2021. Between 1988-2000, day 100 non-relapse mortality (NRM) was 6%, whereas from 2001 onwards NRM remained ≤ 1% (p<0.001). Conclusions This single-center analysis of over 3,000 newly diagnosed MM patients undergoing upfront autoHCT demonstrates significant improvements in the depth of response and survival outcomes over the past three decades, even in patients with high-risk disease. NRM remained <1% despite increasing age and comorbidity burden.
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 | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
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 ».