Autologous transplantation in 495 multiple myeloma patients – analysis from the Czech National Registry of Hematopoietic Stem Cell Transplantation
Authors:
M. Krejčí 1; B. Vacková 2; H. Krejčová 2; V. Maisnar 3; P. Žák 3; E. Faber 4; J. Vondráková 4; T. Kozák 5; E. Gregora 5; A. Vítek 6; M. Trněný 7; M. Trnková 7; A. Svobodník 8; V. Ščudla 9; J. Bačovský 9; I. Špička 2; J. Straub 2; L. Jebavý 3; Z. Adam 1; L. Pour 1; R. Hájek 1
Authors‘ workplace:
Interní hematoonkologická klinika, FN Brno, 2I. interní klinika, VFN Praha, 3II. interní klinika – Oddělení klinické hematologie
LF a FN Hradec Králové, 4Hematoonkologická klinika, FN Olomouc, 5Oddělení klinické hematologie, FN KV
Praha, 6Ústav hematologi
1
Published in:
Transfuze Hematol. dnes,13, 2007, No. 2, p. 56-62.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Autologous stem cell transplantation (ASCT) has an important role in the treatment of symptomatic multiple myeloma (MM) patients. The aim of our study was to analyse retrospectively the results of ASCT in 495 MM patients from the Czech National Registry of Hematopoietic Stem Cell Transplantation. The data from 6 transplant centres were evaluated in order to identify significant variables associated with progression free survival (PFS) and overall survival (OS). Patients were transplanted between 1994 and 2005, the median age was 56 years, clinical stages according Durie-Salmon were as follows: stage I – 8 %, stage II – 29 %, stage III – 63 %. Transplantation was performed during the first year from diagnosis in 411 patients (83 %). The median follow-up from ASCT was 33.3 months. Transplant-related mortality to day +100 was 1 %, the median time to neutrophil engraftment was 12 days. The treatment responses after ASCT according to EBMT criteria were recorded in 149 patients (30 %), the complete response (CR) was achieved in 94 patients. Median PFS and OS from transplantation were 27.5 and 62.3 months, respectively. The significant prognostic parameters for both poor PFS and OS were as follows: IgA type of monoclonal immunoglobulin, renal impairment at diagnosis, clinical stage III according to Durie-Salmon and failure to achieve CR after ASCT. The status of disease before transplantation and the age did not significantly affect PFS and OS after ASCT. ASCT in multiple myeloma is a safe and an effective treatment method with a low toxicity. The most significant prognostic factors for longer survival after transplant ASCT are lack of the renal impairment and achievement of CR after transplantation ASCT (p < 0.001).
Key words:
multiple myeloma, autologous stem cell transplantation, complete response, prognostic factors
Sources
1. Bataille R, Harousseau JL. Multiple Myeloma. N Engl J Med 1997; 336:1657–1664.
2. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin 2000; 50:7–33.
3. Adam Z, Bačovský J, Flochová E, et al. Diagnostika a léčba mnohočetného myelomu – Doporučení vypracované Českou myelomovou skupinou, Myelomovou sekcí České hematologické společnosti a experty Slovenské republiky pro diagnostiku a léčbu mnohočetného myelomu. Transf a Hematol 2005; Suppl. 1, 11: 3–51.
4. Attal M, Harousseau JL, Stoppa AM, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.
5. Child JA, Morgan GJ, Davies FE, et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.
6. Blade J, Sureda A, Ribera JM, et al. High-dose therapy autotransplantation/ intensification versus continued conventional chemotherapy in multiple myeloma patients responding to the intitial chemotherapy. Definitive results of the PETHEMA trial after median follow up of 66 months. Blood 2003; 102: abstr. 43a.
7. Fermand JP, Katsahian S, Divine M, et al. High-dose therapy and autologous blood stem-cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long-term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol 2005; 36: 9227–9233.
8. Ščudla V., Bačovský J. Prognostické faktory. In: Adam Z, Hájek R, Mayer J et al. Mnohočetný myelom a další monoklonální gamapathie. 1. vyd. Brno, Masarykova Univerzita, 1999; 157–173.
9. Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23:3412–3420. 10. Durie B, Salmon S. A clinical staging system for multiple myeloma. Cancer 1975; 36: 842–854.
11. Blade J, Samson D, Reece D, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. Br J Haematol 1998; 102:1115–1123.
12. Attal M, Harousseau JL, Facon T, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med 2003; 349: 2495–2502.
13. Krivanova A, Hajek R, Krejci M, et al. Second autologous transplantation for multiple myeloma patients relapsing after the first autograft — a pilot study for the evaluation of experimental maintenance therapies. Report of the prospective non-randomized pilot study of the Czech Myeloma Group. Onkologie 2004; 27: 275–279.
14. Terpos E, Apperley JF, Samson D, et al. Autologous stem cell transplantation in multiple myeloma: improved survival in nonsecretory multiple myeloma but lack of influence of age, status at transplant, previous treatment and conditioning regimen. A single- centre experience in 127 patients. Bone Marrow Transplant 2003; 31:163–170.
15. Alegre A, Diaz-Mediavilla J, San-Miguel J, et al. Autologous peripheral blood stem cell transplantation for multiple myeloma: a report of 259 cases from the Spanish Registry. Spanish Registry for Transplant in MM (Grupo Espanol de Trasplante Hematopoyetico- GETH) and PETHEMA. Bone Marrow Transplant 1998; 21:133–140.
16. Majolino I, Vignetti M, Meloni G, et al. Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo. Haematologica 1999; 84:844–852.
17. Bjorkstrand B. European Group for Blood and Marrow Transplantation Registry studies in multiple myeloma. Semin Hematol 2001; 38:219–225.
18. Sirohi B, Powles R, Mehta J, et al. An elective single autograft with high-dose melphalan: single-center study of 451 patients.Bone Marrow Transplant 2005; 36:19–24.
19. Siegel DS, Desikan KR, Mehta J, et al. Age is not a prognostic variable with autotransplants for multiple myeloma. Blood 1999; 38: 219–225.
20. Barlogie B, Tricot G, Rasmussen E, et al. Total therapy 2 without thalidomide: comparison with total therapy 1: role of intensified induction and post-transplant consolidation therapies. Blood 2006; 107:2633–2638.
21. O’Shea D, Giles C, Terpos E, et al. Predictive factors for survival in myeloma patients who undergo autologous stem cell transplantation: a single-centre experience in 211 patients. Bone Marrow Transplant 2006; 37:731–737.
22. Alexanian R, Weber D, Delasalle K, et al. Clinical outcomes with intensive therapy for patients with primary resistant multiple myeloma. Bone Marrow Transplant 2004; 34:229–234.
23. Badros A, Barlogie B, Siegel E, et al. Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol 2001; 114:822–829
24. San Miguel JF, Lahuerta JJ, Garcia-Sanz R, et al. Are myeloma patients with renal failure candidates for autologous stem cell transplantation? Hematol J 2000, 1:28–36.
25. Knudsen LM, Nielsen B, Gimsing P, Geisler P. Autologous stem cell transplantation in multiple myeloma: outcome in patients with renal failure. Eur J Haematol 2005; 75:27–33.
26. Vesole DH, Tricot G, Jaganath S, et al. Autotransplants in multiple myeloma: what have we learned? Blood 1996; 88:838–847.
Labels
Haematology Internal medicine Clinical oncologyArticle was published in
Transfusion and Haematology Today
2007 Issue 2
Most read in this issue
- Quantification of chimerism by real-time polymerase chain reaction.
- Autologous transplantation in 495 multiple myeloma patients – analysis from the Czech National Registry of Hematopoietic Stem Cell Transplantation
- Detection of the t(14;18) chromosomal translocation from fine-needle aspiration in follicular lymphoma and the significance of so called molecular nodal remission
- Allogeneic Stem Cell Transplantation after Reduced-Intensity Conditioning for Lymphoproliferative Disease (UHKT 1999–2005)