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Current guidelines recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible MM patients. This study seeks to delineate factors influencing post\u2013ASCT outcomes in MM patients. Our cohort comprised 150 MM patients from Taipei Veterans General Hospital, with progression-free survival (PFS) as the primary endpoint and overall survival (OS) as the secondary endpoint. A Cox proportional hazards model was employed to discern potential predictive factors for survival. ASCT age\u2009\u2265\u200965 (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.08\u20133.47) and the presence of extramedullary disease (HR 2.53, 95% CI 1.53\u20134.19) negatively impacted PFS. Conversely, treatment response\u2009\u2265\u2009VGPR before ASCT (HR 0.52, 95% CI 0.31\u20130.87) and total CD34<jats:sup>+<\/jats:sup> cells collected\u2009\u2265\u20094\u2009\u00d7\u200910<jats:sup>6<\/jats:sup> cells\/kg on the first stem cell harvesting (HR 0.52, 95% CI 0.32\u20130.87) were positively associated with PFS. For OS, patients with ISS stage III (HR 2.06, 95% CI 1.05\u20134.04), the presence of extramedullary disease (HR 3.92, 95% CI 2.03\u20137.58), light chain ratio\u2009\u2265\u2009100 before ASCT (HR 7.08, 95% CI 1.45\u201334.59), post\u2013ASCT cytomegalovirus infection (HR 9.43, 95% CI 3.09\u201328.84), and a lower conditioning melphalan dose (&lt;\u2009140 mg\/m<jats:sup>2<\/jats:sup>; HR 2.75, 95% CI 1.23\u20136.17) experienced shorter OS. In contrast, post\u2013ASCT day\u2009+\u200915 absolute monocyte counts (D15 AMC)\u2009&gt;\u2009500\/\u00b5l (HR 0.36, 95% CI 0.17\u20130.79) and post\u2013ASCT day\u2009+\u200915 platelet counts (D15 PLT)\u2009&gt;\u200980,000\/\u00b5l (HR 0.48, 95% CI 0.24\u20130.94) were correlated with improved OS. Significantly, early PLT and AMC recovery on day\u2009+\u200915 predicting longer OS represents a novel finding not previously reported. Other factors also align with previous studies. Our study provides real-world insights for post\u2013ASCT outcome prediction beyond clinical trials.<\/jats:p>","DOI":"10.1007\/s00277-024-05641-y","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T02:09:39Z","timestamp":1710295779000},"page":"2893-2904","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Risk factors of early disease progression and decreased survival for multiple myeloma patients after upfront autologous stem cell transplantation"],"prefix":"10.1007","volume":"103","author":[{"given":"Te-Lin","family":"Hsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Kuang","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiu-Mei","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen-Lan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Tsai","family":"Hsiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Chung","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Hsuan","family":"Chien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao-Yuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Shen","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-An","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Hwang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyh-Pyng","family":"Gau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7945-9292","authenticated-orcid":false,"given":"Chia-Jen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"issue":"8","key":"5641_CR1","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1002\/ajh.26590","volume":"97","author":"SV Rajkumar","year":"2022","unstructured":"Rajkumar SV (2022) Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. 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