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Tytuł:
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Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR)
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Autorzy:
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Bergin, Krystal
Wellard, Cameron
Augustson, Bradley
Cooke, Rachel
Blacklock, Hilary
Harrison, Simon J.
Ho, Joy
King, Tracy
Quach, Hang
Mollee, Peter
Walker, Patricia
Moore, Elizabeth
McQuilten, Zoe
Wood, Erica
Spencer, Andrew
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Źródło:
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Bone Marrow Transplantation; October 2021, Vol. 56 Issue: 10 p2533-2543, 11p
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Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40–60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (≤70 years, ≥12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65–70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65–70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p< 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p< 0.001; diabetes: 19.1% vs 7.0%, p< 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p< 0.001), inferior performance status (ECOG ≥ 2: 26% vs 13%, p< 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p= 0.009, R-ISS-3 18.6% vs 11.8%, p= 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p< 0.001; overall survival (OS): NR vs 64.0 months, p< 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p= 0.04, OS: NR vs 68.2 months, p= 0.002; 65–70 years: median PFS: 46.7 months vs 29.2 months, p< 0.001, OS: 76.9 months vs 55.6 months, p= 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in ‘older’ patients necessitating well-designed studies evaluating ASCT in ‘older’ MM to inform evidence-based patient selection.