High Dose Chemotherapy with Autologous Stem Cell Transplantation for Multiple Myeloma: Outcomes at Tata Memorial Centre

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.…”

Clinical Outcomes in Multiple Myeloma Post-Autologous Transplantation—A Single Centre Experience

“…Table 4 shows transplant data of patients with myeloma from the present study along with other studies from India. Previous reports from India [6][7][8] have shown that ASCT is a safe and feasible option for eligible patients with myeloma in developing countries. Also, most of these transplants have been done with freshly apheresed stem cell grafts without cryopreservation; however unlike at our centre, most have used prophylactic antifungals, antibiotics and antivirals.…”

“…Based on this data, we are now using antifungal prophylaxis with fluconazole 400 mg per day till day 30 in all patients undergoing autologous transplantation and antiviral prophylaxis with acyclovir 400 mg twice daily till day 90 in all patients previously treated with bortezomib. The predictors of survival in previous studies [6][7][8] have been the pre-transplant remission status, pre-transplant PET-CT response, presence of extramedullary disease, ISS stage, Durie-Salmon stage, absolute lymphocyte count at diagnosis, serum albumin less than 3.5 g/dL, more than 2 lines of induction therapy pre-transplant and post-transplant complete response. Consistent with these findings, we noted that pre-transplant remission status and post-transplant remission status seem to be important predictors of survival.…”

“…There is limited data from developing countries on the outcome of ASCT in myeloma to guide such an approach. From India, data is available from three large centres [6][7][8] showing promising long-term outcomes in patients with myeloma undergoing ASCT with pre-and post-transplant responses being predictive of survival. Hence we decided to undertake a retrospective analysis of patients with myeloma who underwent autologous transplantation at our institution over a 20 year period.…”