Objective: To explore the effects of pre-transplant controlling nutritional status (CONUT) and post-transplant minimal residual disease (MRD) on prognosis of patients with multiple myeloma (MM) after autologous hematopoietic stem cell transplantation (auto-HSCT).
Methods: The clinical data of 79 patients who received auto-HSCT from 2011 to 2020 in The First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The patients were divided into Low-CONUT group (n=62) and High-CONUT group (n=17) according to whether the CONUT score was less than 5. The differences in clinical features, hematopoietic reconstruction, adverse reactions, efficacy and survival between the two groups were compared. In addition, the prognostic risk factors were analyzed and verified by time-dependent ROC curve.
Results: The proportions of male patients and bone marrow plasma cells>30% at initial diagnosis in High-CONUT group were both higher than those in Low-CONUT group (both P <0.05). While, there were no significant differences in hematopoietic reconstruction and adverse reactions (>grade 2) between the two groups. The complete response (CR) rate and CR+very good partial response (VGPR) rate before transplantation in Low-CONUT group were both significantly higher than those in High-CONUT group (both P <0.05). After 3 months of transplantation, the CR+VGPR rate still remained an advantage in Low-CONUT group compared with High-CONUT group (P <0.01), but CR rate did not(P >0.05). The overall survival (OS) and progression-free survival (PFS) in Low-CONUT group were both superior to those in High-CONUT group (both P <0.05). Low CONUT score (0-4) before transplantation and negative MRD at 6 months after transplantation were favorable factors affecting OS and PFS (both P <0.05), while the International Myeloma Working Group (IMWG) high-risk at initial diagnosis and lactate dehydrogenase (LDH) level>250 U/L before transplantation were only risk factors for PFS (both P <0.05). Time-dependent ROC curve analysis showed that pre-transplant CONUT score and MRD status at 6 months after transplantation could independently or jointly predict 1- and 2-year OS and PFS, and the combined prediction was more effective.
Conclusion: The combination of pre-transplant CONUT and post-transplant MRD can better predict the prognosis of MM patients.
题目: 移植前控制营养状况和移植后微小残留病灶对多发性骨髓瘤患者自体造血干细胞移植预后的影响.
目的: 探讨多发性骨髓瘤患者自体造血干细胞移植前控制营养状况（CONUT）和移植后微小残留病灶对预后的影响。.
方法: 回顾性分析2011-2020年在本院行自体造血干细胞移植的79例患者的临床资料，根据首次移植前CONUT评分将患者分为Low-CONUT组（0-4分，62例）和High-CONUT组（5-12分，17例），对比分析两组患者的临床特征、造血重建与不良反应、疗效和生存情况，同时对预后进行危险因素分析，并用时间依赖的ROC曲线验证结果。.
结果: High-CONUT组男性患者比例和初诊时骨髓浆细胞>30%的患者比例均较Low-CONUT组高（均P < 0.05），而在造血重建与不良反应（2级以上的非血液学不良反应）方面无显著差异。Low-CONUT组移植前完全缓解率、完全缓解+非常好的部分缓解率都显著高于High-CONUT组（均P <0.05），移植后3个月后者优势仍然保持（P <0.01），但前者已无显著差异（P >0.05）。Low-CONUT组总生存期、无进展生存期均优于High-CONUT组（均P <0.05）。移植前的CONUT评分低（0-4分）、移植后6个月微小残留病阴性是患者总生存期和无进展生存期的有利因素（均P <0.05），初诊时国际骨髓瘤工作组预后危险分层为高危和移植前乳酸脱氢酶>250 U/L仅是无进展生存期的危险因素（均P < 0.05）。时间相关的ROC曲线分析提示，CONUT评分和移植后6个月微小残留病灶状态可单独或联合预测1和2年总生存期、无进展生存期，且联合预测效果更好。.
结论: 结合移植前CONUT评分和移植后微小残留病灶状态可以较好地预测多发性骨髓瘤患者的预后。.
Keywords: autologous hematopoietic stem cell transplantation; controlling nutritional status; minimal residual disease; multiple myeloma; risk factor.