Background: Tandem autologous (auto)/allogeneic (allo) stem cell transplantation (SCT) may improve the outcome of patients (pts) with refractory or poor prognosis multiple myeloma (MM). Patients: From January 1998 to May 2008, 33 pts with MM who underwent tandem auto/allo SCT in our center were retrospectively analyzed. Mean age was 55 years (y) [range 37–72]; M/F was 19/14. At diagnosis pts characteristics were as follows: Salmon-Durie stage III, 26 pts (79 %) and stage II, 6 pts (18 %), respectively (resp.); Ig subtype IgG, 16 pts (49 %), IgA, 9 pts (27 %) and light chains, 7 pts (21 %). Beta-2 microglobulin (B2M) was greater than 3.5 mg/dL in 21 pts (64 %). Cytogenetic data were available in 25 pts. 15 pts (60 %) had a normal karyotype and 10 pts (40 %) a chromosome 13 deletion (del 13). Median time between diagnosis and tandem auto/allo was 32 months (m) [range 7–106]. 32/33 pts received a first-line anthracycline-based chemotherapy. VAD regimen (Vincristine, Adryamycin, Dexamethasone) was induction therapy in 91 % of pts. Auto SCT conditioning was with Melphalan 140 or 200 mg/m2. Pts with del 13 received a tandem auto/allo SCT in first response (30 %), as a planned procedure. However 23 pts (70 %) were chemorefractory and had presented relapse (16 pts) or progression (7 pts) before tandem auto/allo SCT. Among these refractory pts, 8 pts had received 2 lines, 8 pts 3 lines and 7 pts more than 3 lines of treatment, before tandem auto/allo SCT. The disease status at allo SCT included complete response (CR) in 4 pts (12 %), very good partial response (VGPR) in 4 pts (12 %) and partial response (PR) in 12 pts (36 %) resp, according to IMWG. 27 pts (82 %) received SCT from HLA-matched siblings and 6 pts (18 %) from unrelated donors, resp. Allogeneic SCT conditioning was myeloablative in 7 pts (21 %) and associated TBI 12 Gy and Cyclophosphamide 120 mg/kg, whereas it was non myeloablative in 26 pts (79 %) and associated Fludarabine 30 mg/m2/d during 4 days (d), Busulfan 2 mg/kg/d during 2 d and antithymocyte globulin (ATG). GVHD prophylaxis associated Cyclosporine and Methotrexate. Results: All pts had a sustained donor engraftment. 7/33 pts (21 %) experienced acute GVHD (aGVHD), of whom 2 pts had grade III–IV. 5/33 pts (15 %) developed chronic GVHD (cGVHD), of whom 3 pts had grade III–IV. Cumulative incidence of non relapse mortality (NRM) at 100 d and 1 y, was 24 % and 30 % resp. NRM was related to pneumonia in 88 % of cases. Median follow-up post-tandem auto/allo SCT was 4.3 y [range 0.2–9]. Estimated overall survival (OS) was 54 % [95 % CI 37–70] at 1 y and 31 % [95 % CI 17–50] at 5 y post transplantation. Estimated event-free survival (EFS) was 35 % [95 % CI 21–52] at 1 y and 17 % [95 % CI 8–35] at 5 y post-tandem, with an evidence of a plateau to the curve after 3 y. The overall response rate (OR) was 73 %, with 10 pts (30.5 %), 5 pts (15 %) and 9 pts (27.5 %) achieving CR, VGPR and PR, resp. According to clinical characteristics at diagnosis (age, B2M, del 13), OR was not statistically different. However, when performed in first response, tandem auto/allo SCT was associated with a higher OR (90 % vs 65 %) (p = NS). With current follow-up, EFS was not statistically different for pts receiving tandem auto/allo SCT in first response (p = 0.09). Conclusion: Our results suggest that tandem auto/allo SCT is feasible in refractory pts and associated with early toxicity. However tandem SCT may improve the outcome of poor prognosis pts.
Hematopoietic stem cell transplantation (HSCT) offers potentially curative therapy for many hematologic and nonhematologic conditions. As a successful outcome of Qatar's National Cancer Strategy, the HSCT program was started in the National Center for Cancer Care and Research (NCCCR) in October 2015. The HSCT program in NCCCR is the only transplant program in Qatar and self-sufficient with all three core components: the stem cell collection facility, the stem cell processing facility, and the clinical program, which are locally available at Hamad Medical Corporation. In this paper, we report on the outcomes of the first 16 patients who underwent autologous stem cell transplantations (ASCTs) in our center. A total of 17 ASCT have been performed for 16 adult (≥14years) patients. Thirteen of the 16 patients were eligible for disease evaluation at Day 100 post-ASCT. Among these patients, the overall response rate on Day 100 was 92% (complete remission, 61%; very good partial remission/partial remission, 31%) and stable disease occurred in 6%. The procedure was very well tolerated by all patients. At the time of writing this report, all patients are alive; however, one patient (6%) had disease relapse. The Day 100 post-ASCT nonrelapse mortality rate was 0%. Launching the HSCT program represents a historic milestone in the development of the health-care sector in Qatar. The 1st year of this program was very fruitful with the accomplishment of 17 successful transplants. We are in the process of starting the allogenic HSCT early next year. This would represent the next significant milestone for cancer care in Qatar.
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