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

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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.

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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.

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Authors and Affiliations

  1. Department of Hemato-Oncology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute and Research Centre, Sector – 5, Rohini, New Delhi, 110085, India

    Mukul Aggarwal, Narendra Agrawal, Neha Yadav, Priyanka Verma, Rayaz Ahmed, Pallavi Mehta, Jyotsna Kapoor & Dinesh Bhurani

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  1. Mukul Aggarwal
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  2. Narendra Agrawal
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  3. Neha Yadav
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  4. Priyanka Verma
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  5. Rayaz Ahmed
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  6. Pallavi Mehta
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  7. Jyotsna Kapoor
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  8. Dinesh Bhurani
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Correspondence to Dinesh Bhurani.

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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.

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The authors declare that they have no conflict of interest.

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Submission of manuscript implies that the work described has not been published before, and it is not under consideration for publication anywhere else. Its publication is approved by all co-authors as well as by the institute where work has been carried out.

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Aggarwal, M., Agrawal, N., Yadav, N. et al. Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma. Ann Hematol 97, 1869–1877 (2018). https://doi.org/10.1007/s00277-018-3370-1

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  • DOI: https://doi.org/10.1007/s00277-018-3370-1

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