Autologous stem cell transplant in patients with multiple myeloma, experience of 9 years
Keywords:
Haematopoietic stem cell transplantation, Multiple myeloma, Autologous transplantation, SurvivalAbstract
Objective: Multiple myeloma in Colombia is the one of the main reasons for autologous hematopoietic stem cell transplantation (HSCT). The aim of this study is to describe the results of the HSCT in adult patients diagnosed with multiple myeloma in the Fundación Valle del Lili.
Materials and methods: An observational, descriptive study of a retrospective cohort was carried out. Patients older than 18 years with a diagnosis of multiple myeloma with autologous HSCT between 2008 and 2016 were included. The outcomes were overall survival, progressionfree
survival, and post-transplant disease response. A descriptive statistical analysis was carried out for all the variables considered in the analysis. The survival analysis was performed using the Kaplan-Meier method.
Results: During the study period, transplants were performed on 103 patients with a diagnosis of multiple myeloma. The median age was 57 years. The subtype of secreted immunoglobulin was 75% IgG, 18% IgA, 5% non-secretor, and 2% oligo-secretor. The majority of patients were in Durie Salmon stage was IIIA (43.7%). Prior to transplantation 31% had a very good partial response, 25.2% complete response, 19.4% partial response, 10.7% progressive disease, 6.8% stable disease, 2.9% complete strict response, and in 3.9% of the patients the report of the disease status was not found. The 5-year overall survival was 71% (95% CI: 53-83) and progressionfree survival was 40% (95% CI 25-54). After transplantation 33% of the patients were in very
good partial response, 25% in strict complete response, 22% in complete response, 12% partial response, and 8% progressive disease or relapse.
Conclusion: Autologous HSCT is a strategy that is associated with good survival rates, low toxicity, and an adequate post-transplant disease response.
Author Biographies
Francisco Jaramillo, Universidad ICESI
Hemato-oncología y trasplante de médula ósea, Fundación Valle del Lili,Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
Elena Useche, Universidad ICESI
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
Juan García, Universidad ICESI
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
María Rosales, Fundación Valle del Lili
Hemato-oncología y trasplante de médula ósea, Fundación Valle del Lili, Cali, Colombia
Eliana Manzi, Fundación Valle del Lili
Facultad de Ciencias de la Salud, Universidad Icesi, Centro de investigaciones clínicas, Fundación Valle del Lili, Cali, Colombia
Mayra Estacio, Fundación Valle del Lili
Facultad de Ciencias de la Salud, Universidad Icesi, Centro de investigaciones clínicas, Fundación Valle del Lili, Cali, Colombia
Joaquín Rosales, Universidad ICESI
Hemato-oncología y trasplante de médula ósea, Fundación Valle del Lili,Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
References
Terpos E. International Myeloma Society. Multiple Myeloma: Clinical Updates From the American Society of Hematology Annual Meeting 2016. Clin Lymphoma Myeloma Leuk. 2017;17:329-39.
https://doi.org/10.1016/j.clml.2017.02.010
Röllig C, Knop S, Bornhäuser M. Multiple myeloma. Lancet. 2015;385:2197-208.
https://doi.org/10.1016/S0140-6736(14)60493-1
Gay F, Engelhardt M, Terpos E, Wäsch R, Giaccone L, Auner HW, et al. From transplant to novel cellular therapies in multiple myeloma: European Myeloma Network guidelines and future perspectives. Haematologica. 2018;103:197-211.
https://doi.org/10.3324/haematol.2017.174573
Kumar SK, Rajkumar V, Kyle RA, van Duin M, Sonneveld P, Mateos MV, et al. Multiple myeloma. Nat Rev Dis Prim. 2017;3:17046.
https://doi.org/10.1038/nrdp.2017.46
Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975;36:842-54.
https://doi.org/10.1002/1097-0142(197509)36:3<842::AID-CNCR2820360303>3.0.CO;2-U
Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, et al., International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17:e328-46.
https://doi.org/10.1016/S1470-2045(16)30206-6
Hari P. Recent advances in understanding multiple myeloma. Hematol Oncol Stem Cell Ther. 2017;10:267-71.
https://doi.org/10.1016/j.hemonc.2017.05.005
Krejci M, Scudla V, Tothova E, Schutzova M, Koza V, Adam Z, et al. Long-term outcomes of autologous transplantation in multiple myeloma: Significant survival benefit of novel drugs in post-transplantation relapse. Clin Lymphoma Myeloma. 2009;9:436-42.
https://doi.org/10.3816/CLM.2009.n.086
Sarmiento M, Lira P, Ocqueteau M, Rodríguez MA, García MJ, Jara V, et al. Experiencia de 22 a˜nos de trasplante autólogo de células hematopoyéticas en pacientes con mieloma múltiple o amiloidosis sistémica. 1992-2014. Rev Med Chil. 2014;142:1497-501.
https://doi.org/10.4067/S0034-98872014001200001
Todaro J, Manhani AR, Kutner JM, Ribeiro AA, Rodrigues M, Kerbauy FR, et al. Autologous stem-cell transplantation for multiple myeloma: a Brazilian institution experience in 15 years offollow-up. Einstein (Sao Paulo). 2011;9:119-23.
https://doi.org/10.1590/s1679-45082011ao1845
Dhakal B, Szabo A, Chhabra S, Hamadani M, D'Souza A, Usmani SZ, et al. Autologous Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Novel Agent Induction. JAMA Oncol. 2018;4:343-50.
https://doi.org/10.1001/jamaoncol.2017.4600
Gay F, Oliva S, Teresa Petrucci M, Conticello C, Catalano L, Corradini P, et al. Chemotherapy plus lenalidomide versus autologous transplantation, followed by lenalidomide plus prednisone versus lenalidomide maintenance, in patients with multiple myeloma: a randomised, multicentre, phase 3 trial. Lancet Oncol. 2015;16:1617-29.
https://doi.org/10.1016/S1470-2045(15)00389-7
Adekola KU, Bashir Q, Shah N, Pingali SR, Parmar S, Popat UR, et al. Characteristics of multiple myeloma patients with 6-year or longer progression-free survival after a single autologous transplant. Blood. 2013;122:3366.
https://doi.org/10.1182/blood.V122.21.3366.3366
Gonsalves WI, Gertz MA, Dispenzieri A, Lacy MQ, Lin Y, Singh PP, et al. Implications of continued response after autologous stem cell transplantation for multiple myeloma. Blood. 2013;122:1746-9.
https://doi.org/10.1182/blood-2013-03-492678
Kapoor P, Kumar SK, Dispenzieri A, Lacy MQ, Buadi F, Dingli D, et al. Importance of achieving stringent complete response after autologous stem-cell transplantation in multiple myeloma. J Clin Oncol. 2013;31:4529-35.
https://doi.org/10.1200/JCO.2013.49.0086
Kyle RA. Role of maintenance therapy after autologous stem cell transplant for multiple myeloma: lessons for cancer therapy. Mayo Clin Proc. 2011;86:419-20.
https://doi.org/10.4065/mcp.2011.0171
McCarthy PL, Owzar K, Anderson KC, Hofmeister CC, Hassoun H, Hurd DD, et al. Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous stem cell transplant (ASCT) for multiple myeloma (MM): CALGB 100104. J Clin Oncol. 2010;28 15 suppl:8017.
https://doi.org/10.1200/jco.2010.28.15_suppl.8017
Samaras P, Blickenstorfer M, Haile S, Siciliano RD, Petrausch U, Mischo A, et al. Validation of prognostic factors and survival of patients with multiple myeloma in a real-life autologous stem cell transplantation setting: a Swiss single centre experience. Swiss Med Wkly. 2011;141, w13203.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Todos los derechos reservados.
