High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome

Abstract

Background & objectives:Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed.Methods:Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2.Results:Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] −213 (61%)], very good partial response (VGPR) −62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (≥3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ≥3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome.Interpretation & conclusions:Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.

Cost of Treatment of Multiple Myeloma in a Public Sector Tertiary Care Hospital of North India

“…Although the disease remains incurable, there have been advancements on the therapeutic front concurrent with an improved understanding of disease dynamics [6]. Advent of high dose therapy supported with autologous stem cell transplantation (ASCT) as a treatment modality in MM has been reported to have promising results [7][8][9][10][11][12][13][14][15].…”

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“…Частота достижения полной ремиссии после аутоТГСК в группах больных с различным ответом на индукционную химиотерапию (цит. по [22]) аутоТГСК -трансплантация аутологичных гемопоэтических стволовых клеток; охЧР -очень хорошая частичная ремиссия; ПЗ -прогрессирование заболевания; ПР -полная ремиссия; СЗ -стабилизация заболевания; ЧР -частичная ремиссия. Общая выживаемость (вероятность)…”

“…Complete remission rate after auto-HSCT in the groups of patients with diff erent response to induction chemotherapy (quoted from[22]) аутоТГСК -autologous hematopoietic stem cell transplantation; охЧР -very good partial remission; ПЗ -progressive disease; ПРcomplete remission; СЗ -stable disease; ЧР -partial remission.…”

How i treat myeloma?

“…This comprises of, initial disease bulk reduction with systemic therapy, followed by high dose chemotherapy with autologous stem cell rescue and necessity of maintenance therapy and treatment of relapsed disease. [12][13][14] All along this, the importance of supportive care of pain, pathological fracture, hypercalcemia, infections, anemia, hyperviscosity, renal insufficiency, rehabilitation, etc are never forgotten.…”