Autologous Stem Cell Transplantation for Multiple Myeloma: Single Centre Experience from North India

Abstract

Autologous stem cell transplantation (ASCT) is considered as standard of care in patients with multiple myeloma (MM) patients aged 65 years or younger. We analyzed data of 94 patients of plasma cell dyscrasias who underwent 95 autologous transplants at our institute from October 2003 to Aug 2016. Other than 76 patients of newly diagnosed multiple myeloma, we also transplanted two patients of POEMS syndrome, two patients of plasma cell leukemia, three patients of concurrent light chain deposition disease, three patients of multifocal plasmacytomas, and eight patients of isolated light chain myeloma. One patient underwent transplant twice. The median age of patients was 53 years (range 21-65). The average interval between diagnosis and transplant was 10.51 ± 5.42 months. The predominant stage in the study cohort was ISS-III. IgG kappa was the commonest subtype of plasma cell dyscrasia (27.9%) followed by IgG lambda (16.27%). Renal involvement was seen in 25% patients at the time of transplantation. Following chemotherapy, 42% patients were in CR, 39% in VGPR, 5% had PR and 14% had progressive disease at the time of transplantation. All patients were conditioned with melphalan (dose 120-200 mg/m) except for one who received an additional bortezomib for his second transplant. The mean time to neutrophil and platelet engraftment was 11.09 ± 1.82 and 12.69 ± 4.55 days respectively. Mucositis was noted in all patients (grade 3 in 37.5% patients). The median PFS (biochemical) was 55.8% and PFS (clinical) was 76.7% at 6.5 years. Thirteen percent of the transplanted patients succumbed to their illness of which three patients died within 30 days of transplant. Median OS was 76.7% at 6.5 years. ASCT is a feasible option for MM in India and the results are comparable.

Stem Cell Transplantation in Multiple Myeloma: Very Much Alive and Kicking

“…Invasive fungal infection is the primary cause of mortality in management of hematological diseases in our country as was responsible for 50% mortality in this series as well [17]. This is an Table 1 Outcomes of transplantation in multiple myeloma from various other centers of India Kumar et al [19] Malhotra et al [9] Kulkarni et al [7] Aggarwal et al [11] Gokarn et al [13] Naithani et al [ important aspect when considering a transplant in developing countries where the environment plays a significant role in precipitating infections and rakes debate on routine antifungal prophylaxis. Role of allogeneic transplantation in Myeloma is debatable.…”

“…There are few challenges for extending transplantation benefits which are specific to our country. The median time to transplantation still averages around ten months in our country from the time of diagnosis (Table 1); this could be attributed to the delayed decision making, poor education status and time taken for arranging finances [7,[9][10][11][12][13]. Lack of universal health care precludes many patients from the benefit of transplantation.…”

Highlights of Abstracts on Hematopoietic Stem Cell Transplant in Annual Conference of ISHBT 2018

“…The 5-year overall survival and progressionfree survival for the entire cohort was 61.6% and 37.2% respectively. Malhotra et al [5], recently published slightly better results of autologous stem cell transplant in 76 patients of multiple myeloma with OS of 76.7% at 6.5 years. We have earlier documented a low (2%) treatment related mortality (TRM) in our cohort of myeloma transplants [6].…”

Hematopoietic Stem Cell Transplantation in India-2017 Annual Update

“…Malhotra et al [8] have published a larger series of 94 patients with myeloma who were conditioned with high dose melphalan. The mean time to neutrophil and platelet engraftment was 11 and 12 days respectively.…”