Autologous stem cell transplantation for multiple myeloma: Long-term results .
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Date
2016-07
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Abstract
Background. Survival of myeloma patients has improved
considerably in the past decade. However, limited data are
available on their long-term outcome. We analysed the data of
225 consecutive patients who underwent autologous stem cell
transplantation (ASCT) at our centre.
Methods. Between April 1990 and December 2013, a
total of 225 patients with multiple myeloma (median age 53
years, range 27–67 years, 69.3% men) underwent ASCT.
High-dose melphalan 200 mg/m2 was used for conditioning.
Before transplant, the patients received induction therapy with
novel agents (thalidomide and dexamethasone, or lenalidomide
and dexamethasone, or bortezomib and dexamethasone); or
vincristine, doxorubicin, dexamethasone; or alkylating agents
(vincristine, melphalan, cyclophosphamide and prednisolone;
or melphalan and prednisolone). The response to transplant
was evaluated using the European Bone Marrow Transplant
criteria, and an intention-to-treat analysis was done.
Results. Four-fifths (79.6%) of our patients had Durie
Salmon Stage (DSS) IIIA and nearly a quarter (24%) of them
had International Stage III disease. Before the transplant,
80.4% of patients had chemosensitive disease. The median
interval from diagnosis to transplant was 10 months (range
2–128 months). Following ASCT, 197 (87.5%) patients
responded. Complete response was obtained in 54.7%, very
good partial response in 19% and partial response in 13.8%.
At a median follow-up of 90 months (range 18–266 months),
the median progression-free survival (PFS) and overall survival
(OS) were 32 and 85.5 months, respectively. The estimated
PFS and OS at 10 years were 29.7% and 43.6%, respectively.
On multivariate analysis, the presence of extramedullary
disease (HR 3.05, p<0.001), and ISS III (HR 0.50, p<0.02)
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Kumar Lalit, Boya Rakesh Reddy, Pai Rohit, Harish P, Mookerjee Anjali, Sainath B, Patekar Mukesh Bhimrao, Sahoo Ranjit Kumar, Malik Prabhat Singh, Sharma OD, Gupta Ritu.Autologous stem cell transplantation for multiple myeloma: Long-term results. National Medical Journal of India. 2016 Jul-Aug; 29(4): 192-199.