Advertisement

Annals of Hematology

, Volume 97, Issue 10, pp 1869–1877 | Cite as

Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma

  • Mukul Aggarwal
  • Narendra Agrawal
  • Neha Yadav
  • Priyanka Verma
  • Rayaz Ahmed
  • Pallavi Mehta
  • Jyotsna Kapoor
  • Dinesh Bhurani
Original Article

Abstract

Autologous stem cell transplant (ASCT) is standard consolidation therapy in management of multiple myeloma (MM) patients. We reviewed records of all consecutive MM patients who underwent ASCT with high-dose melphalan at our center from year 2002 to 2016. A total of 141 ASCT were conducted (90 males and 51 females) with median age of 55 years (23–68 years). Median time from diagnosis to transplant was 7 months (3–79), with majority of patients underwent transplant in first remission, while 17 (12%) patients received transplant beyond first remission. Eighty-three percent patients obtained CR/VGPR post-ASCT. Transplant-related mortality was 2.1%. At a median follow up of 54 months, mean overall survival (OS) and progression-free survival (PFS) group were 128.3 months (95% C.I. 111.9–144.7 months) and 73.8 months (95% C.I. 57.7–89.9 months), respectively. On univariate analysis, OS was adversely affected by renal insufficiency (p = 0.024), while OS was better with CR/VGPR post-ASCT (p < 0.001) and lenalidomide maintenance therapy (p = 0.009). PFS was affected by CR/VGPR pre-ASCT (p = 0.021), CR/VGPR post-ASCT (p < 0.001), and transplant in first remission (p = 0.034). On multivariate analysis, lenalidomide maintenance (versus thalidomide) (p = 0.007) and CR/VGPR response post-ASCT (p = 0.0003) were found to be predictors for better OS and CR/VGPR response at transplant for better PFS (p = 0.038). Transplant in first remission versus beyond first remission showed a trend for better PFS (p = 0.073). Conclusion: Majority of patients obtained CR/VGPR post-ASCT. Longer PFS was seen with patients who were transplanted in first remission.

Keywords

Autologous stem cell transplantation Multiple myeloma First remission Progression-free survival 

Notes

Acknowledgements

We would like to acknowledge Dr. Babita Jangra and Dr. GayatriVishvakarma for their guidance in performing statistical analysis. With the support of our transplant coordinator Mrs. Niharika Bhatia, we were able to retrieve the details and records of patients who received autologous stem cell transplant.

Compliance with ethical standards

Ethical compliance

All the authors stated that the study have been approved by the appropriate institutional review board and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Since this is a retrospective study, no formal informed consent is required.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, Miguel JFS (2014 Nov) International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 15(12):e538–e548CrossRefGoogle Scholar
  2. 2.
    Saad A, Mahindra A, Zhang MJ et al (2014) Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant 20:402–408 e1CrossRefGoogle Scholar
  3. 3.
    Shah N, Callander N, Ganguly S, Gul Z, Hamadani M, Costa L, Sengsayadeth S, Abidi M, Hari P, Mohty M, Chen YB, Koreth J, Landau H, Lazarus H, Leather H, Majhail N, Nath R, Osman K, Perales MA, Schriber J, Shaughnessy P, Vesole D, Vij R, Wingard J, Giralt S, Savani BN, American Society for Blood and Marrow Transplantation (2015) Hematopoietic stem cell transplantation for multiple myeloma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplantat 21(7):1155–1166CrossRefGoogle Scholar
  4. 4.
    Agarwal SP, Rao YN, Gupta S (eds) (2002) Fifty years of cancer control in India. Ministry of Health and Family Welfare, New DelhiGoogle Scholar
  5. 5.
    Kumar R (2002) Stem cell transplantation: Indian perspective. J Ind Acad Clinic Med 3:182–188Google Scholar
  6. 6.
    Kumar L, Boya RR, Pai R, Harish P, Mookerjee A, Sainath B, Patekar MB, Sahoo RK, Malik PS, Sharma OD, Gupta R (2016 Jul-Aug) Autologous stem cell transplantation for multiple myeloma: long-term results. Natl Med J India 29(4):192–199PubMedGoogle Scholar
  7. 7.
    Thoennissen GB, Görlich D, Bacher U, Aufenberg T, Hüsken AC, Hansmeier AA, Evers G, Mikesch JH, Fritz F, Bokemeyer C, Müller-Tidow C, Stelljes M, Mesters RM, Krug U, Kropff MH, Thoennissen NH, Berdel WE (2017) Autologous stem cell transplantation in multiple myeloma in the era of novel drug induction: a retrospective single-center analysis. Acta Haematol 137(3):163–172CrossRefGoogle Scholar
  8. 8.
    Child JA, Morgan GJ, Davies FE et al (2003) High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 348:1875–1883CrossRefGoogle Scholar
  9. 9.
    Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, Casassus P, Maisonneuve H, Facon T, Ifrah N, Payen C, Bataille R (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med 335:91–97CrossRefGoogle Scholar
  10. 10.
    Lenhoff S, Hjorth M, Holmberg E, Turesson I, Westin J, Nielsen JL, Wislöff F, Brinch L, Carlson K, Carlsson M, Dahl IM, Gimsing P, Hippe E, Johnsen HE, Lamvik J, Löfvenberg E, Nesthus I, Rödjer S (2000) Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Blood 95:7–11PubMedGoogle Scholar
  11. 11.
    Tariman J, Faiman B (2011) Multiple myeloma. In: Yarbro CH, Wujcik D, Gobel BH (eds) Cancer nursing principles and practice. 7. Jones and Bartlett, Massachusetts, pp 1513–1545Google Scholar
  12. 12.
    Dunavin NC, Wei L, Elder P, Phillips GS, Benson DM Jr, Hofmeister CC, Penza S, Greenfield C, Rose KS, Rieser G, Merritt L, Ketcham J, Heerema N, Byrd JC, Devine SM, Efebera YA (2013 Aug) Early versus delayed autologous stem cell transplant in patients receiving novel therapies for multiple myeloma. Leuk Lymphoma 54(8):1658–1664CrossRefGoogle Scholar
  13. 13.
    Lahuerta JJ, Mateos MV, Martínez-López J, Rosiñol L, Sureda A, de la Rubia J, García-Laraña J, Martínez-Martínez R, Hernández-García MT, Carrera D, Besalduch J, de Arriba F, Ribera JM, Escoda L, Hernández-Ruiz B, García-Frade J, Rivas-González C, Alegre A, Bladé J, San Miguel JF (2008) Influence of pre-and post-transplantation responses on outcome of patients with multiple myeloma: sequential improvement of response and achievement of complete response are associated with longer survival. J Clin Oncol 26(35):5775–5782CrossRefGoogle Scholar
  14. 14.
    Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, Stoppa AM, Hulin C, Benboubker L, Garderet L, Decaux O, Leyvraz S, Vekemans MC, Voillat L, Michallet M, Pegourie B, Dumontet C, Roussel M, Leleu X, Mathiot C, Payen C, Avet-Loiseau H, Harousseau JL, IFM Investigators (2012) Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 366(19):1782–1791CrossRefGoogle Scholar
  15. 15.
    MacCarthy PL, Owzar K, Hofmeister CC et al (2012) Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 366(19):1770–1781CrossRefGoogle Scholar
  16. 16.
    Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L, Agha IY, Bourhis JH, Garderet L, Pegourie B, Dumontet C, Renaud M, Voillat L, Berthou C, Marit G, Monconduit M, Caillot D, Grobois B, Avet-Loiseau H, Moreau P, Facon T, for the Inter-Groupe Francophone du Myelome (IFM) (2006 Nov 15) Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 108(10):3289–3294CrossRefGoogle Scholar
  17. 17.
    Stewart AK, Trudel S, Bahlis NJ, White D, Sabry W, Belch A, Reiman T, Roy J, Shustik C, Kovacs MJ, Rubinger M, Cantin G, Song K, Tompkins KA, Marcellus DC, Lacy MQ, Sussman J, Reece D, Brundage M, Harnett EL, Shepherd L, Chapman JAW, Meyer RM (2013 Feb 28) A randomized phase 3 trial of thalidomide and prednisone as maintenance therapy after ASCT in patients with MM with a quality-of-life assessment: the National Cancer Institute of Canada Clinicals trials group myeloma 10 trial. Blood 121(9):1517–1523CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hemato-Oncology and Bone Marrow TransplantRajiv Gandhi Cancer Institute and Research CentreNew DelhiIndia

Personalised recommendations