Analysis of early efficacy and immune reconstitution after autologous hematopoietic stem cell transplantation in multiple myeloma

This retrospective study aimed to stress the advantages of autologous hematopoietic stem cell transplantation (auto-HSCT) in treating primary MM. Ninety-four MM patients who underwent initial parallel sequential auto-HSCT were selected. Data on efficacy (efficacy evaluation, renal function and hemoglobin recovery), immune reconstitution (B-cell subsets, immunoglobulin levels, T-cell subsets, NK cells, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR)) and hematopoietic reconstitution times were collected and analyzed. Whether in all selected patients or in groups R-ISS II-III, there was a notable increase in the proportion of patients achieving in a very good partial response (VGPR) or better (P < 0.001, P = 0.02) and a complete response (CR) or better (P = 0.007, P = 0.014) after transplantation compared to the pre-transplant status. Post-Transplant Immune Reconstitution Analysis (Baseline vs. Pre-Transplant and Pre-Transplant vs. Post-Transplant): The level of CD19 + B cells, CD20 + B cells, CD22 + B cells, CD3 + T cells, IgG and LMR showed the same change trend, that is, it decreased before transplantation (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P<0.007, P < 0.001) and then increased significantly after transplantation(P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001). CD3 + CD4 + T cells from 545.97 (342.11,708.60)/µL to 342.93 (168.38, 475.52)/µL (P < 0.001) and then to 251.48 (188.52, 406.98)/µL (P = 0.348); CD3 + CD8 + T cells from 391.36 (242.19, 563.37)/µL to 337.23 (192.54, 505.96)/µL (P = 0.065) and then to 797.96 (514.49, 1198.03)/µL (P < 0.001), so the CD3 + CD4+/CD3 + CD8 + T cell ratio still remained inverted post-transplant. NK cells changed from 309.86 (206.33, 460.96)/µL to 258.31 (160.75, 436.68)/ µL (P = 0.229) and then to 151.08 (108.17, 240.84)/µL (P = 0.007). Auto-HSCT can promote prolonged remission in patients with MM and also overcome some high-risk factors to achieve superior efficacy in group R-ISS II-III. Patients were immunodeficient before transplantation and auto-HSCT facilitated immune reconstitution.