RESUMO
Outcomes for patients with multiple myeloma (MM) have improved in recent years owing to use of novel agents and high-dose therapy followed by autologous stem cell transplant (ASCT). We analyzed the outcomes of 511 consecutive patients treated with novel therapies at our institution between 2006 and 2014 to determine the impact of relapse within 12 months of initiating treatment. A total of 82 patients (16.0%) experienced early relapse, with median time to relapse of 8.0 months (95% confidence interval (CI); 6.3, 8.9). Median overall survival (OS) was significantly worse for this group at 21.0 months (95% CI; 16.3, 27.2) vs not reached (NR) (95% CI; 96.3, NR) for those with late relapse (P<0.001). Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. In multivariate analysis, low albumin and high-risk cytogenetics predicted early relapse. Outcomes of early relapse from early ASCT were also considered; median OS from ASCT for those relapsing within 12 months was 23.1 months (95% CI; 15.7, 32.4) vs 122.2 months (95% CI; 111.5, 122.2) for the remaining patients (P<0.001). Early relapse remains a marker of poor prognosis in the current era, and such patients should be targeted for clinical trials.
Assuntos
Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Citogenética , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Prognóstico , Recidiva , Albumina Sérica , Taxa de Sobrevida , Fatores de Tempo , Transplante Autólogo , Resultado do TratamentoRESUMO
The following four groups of rhesus monkeys were studied for small vessel pathology of the heart, kidney and retina: sham-vasectomized, vasectomized, sham-vasectomized diabetic and vasectomized diabetic. A significant increase was observed in the frequency of pathological changes in small vessels (less than 60 micron diameter), of the heart muscle of nondiabetic vasectomized monkeys, and in sham-vasectomized and vasectomized diabetic monkeys. Further, the thickness of the glomerular capillary basement membrane was also significantly increased in the three experimental groups. In vasectomized diabetic monkeys, the vascular lesions were much greater than in the other two groups. Moreover, in this group one animal had a microaneurysm of a retinal vessel and another had distortion of retinal veins. The monkeys subjected to vasectomy or diabetes alone did not develop these changes. However, the ratio of mural to endothelial cells in retinal vessels was markedly altered in vasectomized and nonvasectomized diabetic monkeys.