Autologous peripheral blood stem cell transplantation for multiple myeloma: a report of 259 cases from the Spanish Registry

Alegre, Adrián; Dı́az-Mediavilla, Joaquı́n; Miguel, Jesús F. San; Martínez, Rafael Martínez; Laraña, J García; Sureda, Anna; Lahuerta, JJ; Morales, Diego Caldieraro; Bladé, Joan; Caballero, Dolores; Rubia, Javier de la; Escudero, Antonio; Díez-Martín, José Luís; Hernández-Navarro, Fernando; Rifón, J.; Odriozola, J; Brunet, S; Serna, Javier de la; Besalduch, Joan; Vidal, M.; Solano, Carlos; León, Ángel; Sánchez, Juan Antonio Lascuraín; Martínez‐Chamorro, Carmen; Fernández-Rañada, JM

doi:10.1038/sj.bmt.1701062

Cited by 119 publications

(101 citation statements)

References 6 publications

(12 reference statements)

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“…The response rate is high and it is similar to that reported from other large studies. 20,21 The TRM (3% in our study) was also similar to the findings of other groups. 20,22,23 Advanced age has been shown to be a negative prognostic factor in some trials using ASCT for MM.…”

Section: Discussionsupporting

confidence: 80%

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Krejčí

Büchler

Hájek

et al. 2004

Bone Marrow Transplant

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Summary:Autologous stem cell transplantation (ASCT) has an established role in the treatment of symptomatic multiple myeloma (MM). Our aim was to analyse the impact of selected prognostic parameters on the survival of patients with MM after ASCT. The new International Staging System (ISS) was also evaluated. A total of 133 MM patients were transplanted in our centre between 1995 and 2002. Following ASCT, 35% of patients were in complete remission (CR) and 60% were in partial remission (PR). The median progression-free (PFS) and overall (OS) survival from transplantation were 29.5 and 68.8 months, respectively. Transplant-related mortality (TRM) was 3%. On multivariate analysis, factors associated with significantly shorter OS were lack of CR after transplant (P ¼ 0.002, hazard ratio (HR): 3.1), stage 3 according to ISS (P ¼ 0.001, HR: 3.0) and age at transplant over 60 years (P ¼ 0.035, HR: 2.0). The status of disease before ASCT did not significantly affect PFS and OS after transplantation. We conclude that ASCT is a safe and effective procedure in MM patients, associated with low TRM. The survival after ASCT was dependent on response after ASCT, stage according to ISS and age. Reliable and simple staging of MM is important for accurate prognostic evaluation and for the comparison of data from different clinical trials. Attempts to improve the widely accepted Durie-Salmon (DS) staging system 2 have led to the development of numerous new prognostic systems, 3-5 which have not been universally accepted. Recently, Greipp et al 6,7 presented a new International Staging System (ISS) for MM. It has shown promise in patients treated by conventional as well as high-dose chemotherapy and is based on a simple combination of serum b 2 -microglobulin and albumin values (stage 1 ¼ b 2 -microglobulin o3.5 mg/l and albumin X3.5 g/dl; stage 2 ¼ b 2 -microglobulin o3.5 mg/l and albumin o3.5 g/dl, or b 2 -microglobulin X3.5 mg/l to o5.5 mg/l; stage 3 ¼ b 2 -microglobulin X5.5 mg/l).When compared with standard-dose chemotherapy for MM, high-dose chemotherapy with autologous stem cell transplantation (ASCT) has been found to be significantly superior in terms of complete remission (CR), CR duration, progression-free survival (PFS) and overall survival (OS). [8][9][10][11][12] We have retrospectively analysed 133 patients with MM undergoing ASCT in our centre. The aims of our analysis were (1) to evaluate both ISS and DS systems in our set of patients; (2) to ascertain the feasibility and toxicity of the transplant procedure; (3) to evaluate the influence of some clinically important parameters (age, gender, type of MM, stage of MM, responses before and after ASCT, selected laboratory values at transplant) on PFS and OS after transplant in order to define the subgroups of patients with different prognosis. Patients and methods Patients and treatmentFrom January 1995 to December 2002, 133 patients with newly diagnosed symptomatic MM with stages I-III according to DS underwent ASCT at the Department of Internal Medicine -Haematooncol...

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Section: Discussionsupporting

confidence: 80%

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Krejčí

Büchler

Hájek

et al. 2004

Bone Marrow Transplant

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“…Cyclophosphamide, both as parent compound and as alkylating moiety, is excreted through the kidney in percentages ranging from 1 to 14%, 19 which seems to be independent of renal function. Busulfan has been employed in preparative regimens for stem cell transplantation in MM patients; 20,21 only negligible amounts of the compound are eliminated through the kidney, as the liver is the major site of drug metabolism. 22 Concerning melphalan, data are more controversial, as several studies have suggested that pharmacokinetic parameters are related to creatinine clearance, 7,23 while other authors demonstrated that the main route of melphalan elimination is spontaneous degradation.…”

Section: Discussionmentioning

confidence: 99%

Safety of autologous hematopoietic stem cell transplantation in patients with multiple myeloma and chronic renal failure

et al. 2000

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Patients with multiple myeloma (MM) and chronic renal failure have generally been excluded from myeloablative therapy programs followed by hematopoietic stem cell support because of the potential increase in transplant-related morbidity and mortality. We here report our experience treating six MM patients with moderate to severe renal insufficiency, with autologous stem cell transplantation. One of these patients required chronic hemodialysis since the diagnosis of MM was made.

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“…To minimize mucositis, the dose of melphalan and busulfan was reduced by 20% in all protocols. Five patients with lymphoma received the BEAM regimen, 20 10 a combination of busulfan and melphalan (Bu-MPH), 21 three patients a combination of busulfan and CTX (Bu-CTX), and the one with lung cancer a combination of VP-16 and CTX. …”

Section: Myeloablative Therapiesmentioning

confidence: 99%

Analysis of feasibility of myeloablative therapy and autologous peripheral stem cell (PBSC) transplantation in the elderly: an interim report

Mazza

Palazzo

Amurri

et al. 1999

Bone Marrow Transplant

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Summary:An interim report evaluating the feasibility of myeloablative therapy followed by peripheral blood stem cell (PBSC) autotransplant in patients aged Ͼ60 years is presented. In the last 2 years 19 patients Ͼ60 years old with several oncological conditions, mostly hematological, underwent PBSC autotransplant either as salvage therapy following relapse or resistance to conventional treatment, or as consolidating therapy as a part of a well defined protocol. There were 13 males and six females; the mean age was 66.9 years (range 61-76 years); nine patients had resistant or relapsed lymphoma, six myeloma, two acute leukemia, one Waldenstrom's disease and one lung cancer. Myeloablative schemes included BEAM exclusively for lymphomas, busulfan and melphalan (Bu-MPH) mainly for myeloma, busulfan and cyclophosphamide (Bu-CTX) for lymphomas and leukemia and VP-16 and CTX for lung cancer. Mobilization of CD34 ϩ cells was achieved in all patients with the combination of high-dose CTX and G-CSF with collections between 2.83 to 19.04 × 10 6 /kg (mean 7.1). All patients engrafted with a median time for recovery of PMN (Ͼ0.5 × 10 3 / l) of 10 days (range 8-12 days) and for PLT (Ͼ20 × 10 3 / l) of 12 days (range 10-17 days). Major responses were obtained in 15 of 16 patients evaluable for response and eight patients entered CR; overall eight patients are in CR, five are alive with disease, five are dead from disease progression and one is dead because of congestive heart failure 7 months following PBSC autotransplant. No early deaths following the procedure occurred; major side-effects were grade I-II mucositis (58%), fever with documented sepsis (10%), pneumonia (5%), cardiac, renal and liver toxicity (5%). Cardiac function was evaluated before and after myeloablative therapy by VEF in all patients; no significant modifications were necessary. In conclusion, our experience demonstrates that myeloablative therapies in older selected patients can be feasible; the feasibility of introducing PBSC

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Autologous peripheral blood stem cell transplantation for multiple myeloma: a report of 259 cases from the Spanish Registry

Cited by 119 publications

References 6 publications

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients

Safety of autologous hematopoietic stem cell transplantation in patients with multiple myeloma and chronic renal failure

Analysis of feasibility of myeloablative therapy and autologous peripheral stem cell (PBSC) transplantation in the elderly: an interim report

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