CM-04. Experience of multiple myeloma treatment with high-dose chemotherapy and autologous hematopoietic stem cell transplants: results from the Hematology Department of Irkutsk Regional Clinical Hospital
Lubov M. Petrova, Tatiana S. Kaporskaya, Andreу N. Rebrikov, Igor V. Kiselev, Vera A. Lyskova, Oksana V. Khoroshikh, Natalia V. Kiseleva, Natalia P. Misharina, Lev Ya. Peliavin, Alexandеr M. Lavshuk
Irkutsk Regional Clinical Hospital, Irkutsk, Russia
Contact: Dr. Lubov M. Petrova, PhD, e-mail: email@example.com
Multiple myeloma (MM) is among the most common hemoblastoses. Despite extending treatment options using novel drugs for the MM therapy, a high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) remains the 1st line treatment strategy in younger patients (<65-70) and allows to increase the overall and progression-free survival rates. The aim of our work was to evaluate the results of MM treatment by means of high-dose chemotherapy followed by auto-HSCT obtained at the Department of Hematology (Irkutsk Regional Clinical Hospital).
Patients and methods
Over the period of 2016 to 2020, auto-HSCT was performed in 47 patients (2016, n=3; 2017, n=5; 2018, n=14; 2019, n=21; 2020, n=4). The isolated stem cell harvests were performed in 4 cases. Single auto-HSCT was carried out in all the cases. Gender and age distribution was as follows: 29 females and 18 males, aged from 39 to 67 years old at the time of MM diagnosis (mediane, 55.7; 15 patients were over 60 years old). The IgG-type MM was registered in 31 patients (66%), IgA type, in 9 cases (19%), Bence Jones myeloma was documented in 7 patients (15%). Renal dysfunction at the onset of the disease was found in 13 patients, two of them received kidney replacement treatment. Bone lesions of different degree were revealed in all the patients. At the time preceding stem cell mobilization, the patients received 2 to 9 rounds of induction therapy including bortezomib. A protocol with bortezomib, cyclophosphamide, dexamethasone was applied in 100% of the cases. By the time of autotransplant harvest, the patients showed the following clinical responses: complete (n=11, 23.4%); very good partial response (n=11, 23.4%); partial response (n=18, 38.3%); stabilization (n=7, 14.9%). To induce mobilization, 45 patients (96%) received cyclophosphamide at a dose of 4 g/m2, with granulocyte colony-stimulating factor (G-CSF). G-CSF at a dose of 10 mcg/kg/day was injected since the decrease of leukocyte numbers to 1.2-1.0×109/L (a mean of 5 to 7 days after cyclophosphamide treatment. In two patients (4%) at the renal replacement therapy, the stem cell harvests were performed with G-CSF only. In one case Plerixafor was used, along with standard schedule. CD34+ cell counts were carried out at the blood leukocyte levels of >5-7×109/L. Leukapheresis was performed at the CD34+ cell levels in peripheral blood of ≥ 10/mcL. In most cases (n=28), a single round of leukapheresis was enough to harvest the sufficient numbers of stem cell transplant. In some cases, however, additional collections were required (2, in 15 cases; 3, in 4 patients). High-dose melphalan was used as a conditioning regimen in all the patients, having been applied at the doses of 200 mg/m2 (n=42), and 140 mg/m2 (n=5). Post-transplant maintenance therapy was as follows: bortezomib in 2 patients (4%); lenalidomide was used in 39 cases (83%), either as monotherapy, or combined with dexamethasone. Six patients (13%) did not receive a treatment, with lethal outcome in one case by unrecognized reason, and lenalidomide therapy was planned for 4 patients.
At the time of evaluation, 45 patients (96%) were alive. The following clinical results are obtained: complete response was achieved in 32 cases (68.1%); partial response in 7 patients (14.9%); very good partial response was observed in two patients (4.3%); progression was documented in four cases (8.5%). The follow-up time was from 1 to 52 (a median of 20) mo. The mean time to progression was 19 mo (8 to 31 mo). Lethal outcome after HSCT was registered in a single case (2.1%) during early posttransplant period, associated with myelosuppression and viral pneumonia. One patient was lost from observation.
Annual increase in auto-HSCT activity is observed at the Hematology Department of Irkutsk Regional Clinical Hospital, thus proving higher availability of this procedure for the regional population. An interim analysis of usage of HSCT in real clinical practice allows to predict increased progression-free survival rates in MM patients after autologous HSCT.
Multiple myeloma, high-dose chemotherapy, autologous hematopoietic stem cell transplantation, clinical outcomes.