Introduction: Autologous stem cell transplantation (ASCT) is the standard treatment for younger patients with newly-diagnosed multiple myeloma (MM). However, due to restrictive exclusion criteria, more than half of eligible patients are usually excluded from transplant-studies.
Methods: This retrospective monocentric analysis included 540 patients with MM who received an ASCT between 1996 and 2019.
Results: Up to 2005, induction therapy consisted mainly of conventional chemotherapies, e.g. vincristine/doxorubicin/dexamethasone (VAD). In the following years, the triple-combinations based on bortezomib coupled with doxorubicin/dexamethasone (PAD), melphalan/prednisolone (VMP), cyclophposphamide/dexamethasone (VCD) or bendamustine/prednisolone (BPV) became the most popular treatment options. A progressive improvement in PFS was observed in patients treated with the two current induction therapies BPV (47 months) or VCD (54 months) compared to VAD (35 months, p<0.03), PAD (39 months, p<0.01 and VMP (36 months, p<0.01). However, there was no significant difference in median OS (VAD 78, PAD 74, VMP 72, BPV 80 months and VCD not reached). In our analysis, we also included 139 patients who do fulfill at least one of the exclusion criteria for most phase 3 transplant-studies (POEMS/amyloidosis/plasma cell leukemia, eGFR<40 mL/min, severe cardiac dysfunction or poor general condition). Outcome for these patients was not significantly inferior compared to patients who met the inclusion criteria for most of the transplant studies with PFS of 36 vs 41 months (p=0.78) and OS of 78 vs 79 months (p=0.34).
Conclusions: Our real world data in unselected pts also stress the substantial value of ASCT during the first line treatment of younger MM pts.:Inhaltsverzeichnis
Bibliographische Beschreibung …………………………………………………...………………..……….……………………......2
Inhaltsverzeichnis …………………………………………………………………………………………………………………...…........3
Abkürzungsverzeichnis ………………………………………………………………………………………………………………..…….4
1. Einführung …………………………………………………………………..…………………..…...................................7
1.1. Das multiple Myelom ………………………………………………….……………………………..………………………..7
1.2. Klinik und Diagnostik ……………………………………………………………………………..…………………………….7
1.3. Stadieneinteilung ……………………………………………………………….…………..…………………………………...8
1.4. Remissionsbeurteilung ……………………………………………………………………………………………………….10
1.5. Therapie …………………………………………………………………………………………….……………………………...12
1.5.1. Konventionelle Chemotherapie ……………………………………………………………………………………….…12
1.5.2. Neue Substanzen in der Myelomtherapie …………………………………………………………………………..13
1.5.2.1. Immunmodulatorische Substanzen ……………………………………………………………………………….……13
1.5.2.2. Proteasomen-Hemmer ……………………………………………………………………………………….………………13
1.5.2.3. HDAC Hemmer ……………………………………………………………………………………………………………………13
1.5.2.4. Monoklonale Antikörper …………………………………………………………………………………………………….14
1.5.2.5. BCMA basierte Therapien …………………………………………………………………………………………………..14
1.5.3. Autologe Stammzelltransplantation in der Ära der konventionellen Chemotherapie ………...15
1.5.4. Allogene Stammzelltransplantation …………………………………………………………………………………….15
1.5.5. Autologe Stammzelltransplantation in der Ära der neuen Substanzen ………………………………..16
1.6. Aufgabenstellung der Arbeit ……………………………………………………………………………………………….17
2. Publikation …………………………………………………………………………………………………………………….……18
3. Zusammenfassung der Arbeit ……………………………………………………………………………………………..33
Literatur …………………………………………………………………………………………………………………………………..…..…37
Tabellenverzeichnis …………………………………………………………………………………………………………………………49
Darstellung des eigenen Beitrags …………………………………………………………………………………………………….50
Selbständigkeitserrklärung ………………………………………………………………………………………………………………52
Lebenslauf ……………………………………………………………………………………………………………………………………….53
Verzeichnis der wissenschaftlichen Veröffentlichungen……………………………………………………………………54
Danksagung ……………………………………………………………………………………………………………………………………..56
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:92017 |
| Date | 12 June 2024 |
| Creators | Wang, Song-Yau |
| Contributors | Universität Leipzig |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | German |
| Detected Language | English |
| Type | info:eu-repo/semantics/acceptedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 10.1007/s00432-022-04184-x |
Page generated in 0.0023 seconds