10-year experience in the treatment of multiple myeloma with autologous stem cell transplantation
Journal
Bone Marrow Transplantation Journal
Date Issued
2011
Author(s)
Ivanovski, Martin
Dukovski, Dushko
DOI
10.1038/bmt.2011.48
Abstract
Background: Multiple myeloma (MM) is a plasma-cell proliferative
neoplasm.The second most common hematologic cancer,
with 5 years prevalence about 183 000. Incidence is 5,7 /100
000 in EU. 5-years survival is 28%. Treatment with HDT and single
autologous transplantation is a category I recommendation
of the NCCN. In young patients, the impact of dose intensity has
been demonstrated, and single HDT supported with ASCT using
a conditioning regimen with Melphalan should be considered a
standard of care. Double transplantation can be proposed to
patients failing to achieve a VGPR after a fi rst ASCT.
Material and methods: during a 10 years period we have performed
195 stem-cell transplantation in different hematological
malignancies. 34 (17,5%) high dose chemotherapy and autologous
stem-cells transplantation were performed in 30 patients
(4 tandem transplantation) with multiple myeloma. In this trial
we retrospectively analyzed the epidemiology characteristic of
this patients. Gender: Female: 16 Male: 14. Median age: 51
years (from 43- 64 years).
Results: Diagnose was made according to Salmon and Durie
criteria. 25 patients with IgG, 4 with IgA, and 1 with light chain
myeloma. Bence-Jones positive myeloma was diagnosed in
8 patient, 5 of them were with chronic renal failure. Fracture of
spine was presented in 12 patients and 2 patients has fracture
of hip. For the induction of remission we used VAD regimen in
20 patients, Cy-Tal-Dex in 10 patients. As a second line therapy
in the case of failure to achieve complet remission we introduce
Thal/Dex regimen. in 10 patient Only in two patient we use
Bortezomib, Alkeran, Dexamethason. Conditioning regimen
consisted Melphalan 200 mg/m2. In tandem transplantation
the dose of second conditioning was 140 mg/m2.The volume
of CD34+ cells was 3,88 x 108/Kg.bw. Period from diagnose to
transplantation is 12 months. From 30 patients 80% are alive,
6 died (3 renal failure, 2 fatal cerebral bleeding and 1 multiorgan
failure). The DFS is 24 months, OS is 48 months and
survival after transplantation is 35 months.
Conclusion: novel agents such as thalidomide, bortezomib, or
lenalidomide have been introduced to improve high-dose therapy,
and promising results have been reported. Conversely,
results from myeloablative allogeneic stem cell transplantation
remain disappointing due to high TRM, justifying the exploration
of strategies such as RIC, which have been shown to be feasible
but for which proof of effi cacy requires continued study.
neoplasm.The second most common hematologic cancer,
with 5 years prevalence about 183 000. Incidence is 5,7 /100
000 in EU. 5-years survival is 28%. Treatment with HDT and single
autologous transplantation is a category I recommendation
of the NCCN. In young patients, the impact of dose intensity has
been demonstrated, and single HDT supported with ASCT using
a conditioning regimen with Melphalan should be considered a
standard of care. Double transplantation can be proposed to
patients failing to achieve a VGPR after a fi rst ASCT.
Material and methods: during a 10 years period we have performed
195 stem-cell transplantation in different hematological
malignancies. 34 (17,5%) high dose chemotherapy and autologous
stem-cells transplantation were performed in 30 patients
(4 tandem transplantation) with multiple myeloma. In this trial
we retrospectively analyzed the epidemiology characteristic of
this patients. Gender: Female: 16 Male: 14. Median age: 51
years (from 43- 64 years).
Results: Diagnose was made according to Salmon and Durie
criteria. 25 patients with IgG, 4 with IgA, and 1 with light chain
myeloma. Bence-Jones positive myeloma was diagnosed in
8 patient, 5 of them were with chronic renal failure. Fracture of
spine was presented in 12 patients and 2 patients has fracture
of hip. For the induction of remission we used VAD regimen in
20 patients, Cy-Tal-Dex in 10 patients. As a second line therapy
in the case of failure to achieve complet remission we introduce
Thal/Dex regimen. in 10 patient Only in two patient we use
Bortezomib, Alkeran, Dexamethason. Conditioning regimen
consisted Melphalan 200 mg/m2. In tandem transplantation
the dose of second conditioning was 140 mg/m2.The volume
of CD34+ cells was 3,88 x 108/Kg.bw. Period from diagnose to
transplantation is 12 months. From 30 patients 80% are alive,
6 died (3 renal failure, 2 fatal cerebral bleeding and 1 multiorgan
failure). The DFS is 24 months, OS is 48 months and
survival after transplantation is 35 months.
Conclusion: novel agents such as thalidomide, bortezomib, or
lenalidomide have been introduced to improve high-dose therapy,
and promising results have been reported. Conversely,
results from myeloablative allogeneic stem cell transplantation
remain disappointing due to high TRM, justifying the exploration
of strategies such as RIC, which have been shown to be feasible
but for which proof of effi cacy requires continued study.
File(s)![Thumbnail Image]()
![Thumbnail Image]()
Loading...
Name
Bone Marrow Transplantation Journal 46(1).png
Size
200.14 KB
Format
PNG
Checksum
(MD5):977483ebb4862b99b6e33dbc8c117c7b
Loading...
Name
10-year experience in the treatment of multiple myeloma.pdf
Size
113.75 KB
Format
Adobe PDF
Checksum
(MD5):c0a99592ca7c4c171d933d127ff8659c