Characteristics of early posttransplant phase in patients with multiple myeloma and different response to standard chemotherapy: single-center analysis of 130 cases
Galina D. Petrova, Kapitolina N. Melkova, Tatiana Z. Chernyavskaya, Nadezhda V. Gorbunova, Valentina N. Kostrykina, Vadim A. Doronin.
N. N. Blokhin Russian Cancer Research Center, Moscow, Russia
The prognostic impact of chemosensitivity to prior lines of standard chemotherapy (ChT) on outcome after autologous stem cell transplantation (ASCT) is ascertained in majority of haematological malignancies. ASCT is a standard treatment in newly diagnosed young patients (pts) with multiple myeloma (MM). The aim of this study was to analyse the influence of response to standard ChT on characteristics of early post-transplant phase in patients with MM.
Patients and methods
Between 2007 and 2015 102 consecutive pts with MM (49 males) were enrolled in the study. Peripheral blood stem cells (PBSC) were collected and ASCT was performed independently of response to standard CT. If less than complete response (CR)/very good partial response (PR) after the first ASCT had been achieved, the second ASCT was recommended. The same decision was taken in a case of CR/very good PR after 1st ASCT followed by disease relapse/progression (PD).
The first ASCT was administered to 102 pts, 28 pts received the second ASCT (totally 130 ASCT). Median age at ASCT was 51 years (range 29-64). The time interval between diagnosis setting and first ASCT was 5-43 mo (median 10 mo); in 24% cases this interval was more than 1 year. In a period of 3,5-41 mo (median 7 mo), 28 pts received the second ASCT. The disease status at ASCT was: 12% CR, 50% PR, 16% stable disease (SD), 22% PD. Preparative regimen consisted of melphalan (200 mg/m2) in most cases; in 4 cases, the dose was reduced to 100-120 mg/m2, due to severe renal insufficiency. Peripheral blood stem cells (PBSC) grafting was performed in all the cases. Median number of infused PBSC was 4.3 ×106 CD34+cells/kg (range, 2-14,8). Analysis of early post-ASCT phase did not reveal significant hematological and non-hematological toxicity (grade 1-2) in most cases. The median time of neutrophil recovery to >0,5×109/l was 14 days (range, 10-28 days). The median time to platelet recovery to >20×109/l and >50×109/l was 12 days (range, 8-92 days) and 13 days (range, 9-180 days), respectively. Median duration of hospitalization was 22 days (range, 14-83 days). There were no cases of transplant-related mortality. After ASCT, most patients were dynamically followed-up, only 12% received thalidomide, lenalidomide, or bortezomib as maintenance therapy. The subgroup analysis revealed that hematological recovery, intensity of hematological and non-hematological toxicity, duration of hospitalization after ASCT didn’t vary significantly among the patients with different types of response to standard ChT (р>0,05).
ASCT should be performed in all newly diagnosed patients with ММ under 70 years, without absolute contraindications to high-dose CT, regardless of response to standard CT owing to safety of this treatment option and lack of significant differences in early post ASCT phase. This information can have important implication for extension of eligibility to transplantation and maintenance therapy which ultimately would allow for better treatment outcomes in the multiple myeloma patients.
Hematopoietic stem cell transplantation, multiple myeloma, treatment strategy, autologous