scholarly journals Real-World Outcomes of High-Risk Multiple Myeloma: Retrospective Analysis of Cams&pumc

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5658-5658 ◽  
Author(s):  
Weiwei Sui ◽  
Deng Shuhui ◽  
An Gang ◽  
Yan Xu ◽  
Shuhua Yi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Real World ◽  
Standard Treatment ◽  
Hematopoietic Stem

Abstract OBJECTIVE: To record and describe the current status of real world treatment and outcome of patients with high risk multiple myeloma by retrospective ,single-center, non-interventional, observational study METHODS: The data were collected from the CAMS&PUMC estimated real-world outcomes in high-risk multiple myeloma patients between January 2013 to June 2017. RESULTS: A total of 160 patients were enrolled. Of these patients, 1 case discontinued treatment with complications. 52 cases had not received standardized first-line treatment (9 cases of traffic inconvenience, 40 cases were unable to bear treatment costs, and 3 cases were refused consolidation / maintenance therapy after induction). In 107 patients received standardized treatment, the median age 56 years (31-77), 37 and 70 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. In these 37 patients, 4 patients received double auto stem cell transplantation(ASCT), 2 cases of allogeneic hematopoietic stem cell transplantation (allo-SCT), and the other 31 received single ASCT. Immunological subtype IgA was found in 21 cases (19.6%), IgG in 42 cases (39.3%), IgD in 18 cases (16.8%), and light chain in 23 cases (21.4%), non secretory 3 cases(2.8%).The proportion of IgD subtypes was significantly higher than that of MM patients in the same period (5.8%).Non parosteal extramedullary myeloma was found in 24 cases (22.4%), primary plasma cell leukemia in 12 cases (11.2%). 9.3%(10 cases) of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 8.4%(9 cases) had received thalidomide/lenalidomide-based therapy without bortezomib, and 82.2%(88 cases) had received bortezomib plus thalidomide/ lenalidomide-based therapy as frontline treatment, respectively. After a median follow-up of 22.31 months, the median disease-free survival (PFS) and overall survival (OS) were 28.52 and 48.10 months, respectively. Although there was no difference in OS between the treatment regimens, the SCT group had a better survival benefit than the non SCT group. The median PFS in the two group was 46.78 months vs 24.84 months (p=0.037), the SCT group had not reached the median OS, but the median OS in the non SCT group was 43.30 months, and the SCT group could obtain longer survival time than the non SCT group, p=0.012.However, the PFS of single, double and allo-SCT in the SCT group was 46.78, 19.32 and 54.51 months respectively (P single vs double = 0.770, P single vs allo = 0.547, P double vs allo = 0.317), and the three subgroups had not reached the median OS. CONCLUSION: The results of our study suggest that there are significant differences in the treatment regimen used in the real world for the therapy of high risk MM. About 1/3 of high-risk MM patients can not adhere to the standard treatment. Patients who received transplantation were only 34.6% of the patients in the standard treatment. Patients with high-risk MM who receive hematopoietic stem cell transplantation can obtain longer remission time and have significant survival benefits even in the novel drugs era. This diversity provides references for treatment recommendations. Moreover, our results provide real world data for clinical benefits. Disclosures No relevant conflicts of interest to declare.

scholarly journals Lenalidomide maintenance post-transplantation in newly diagnosed multiple myeloma: real-world outcomes and costs

2019 ◽  
Vol 15 (35) ◽  
pp. 4045-4056 ◽  
Author(s):  
Parameswaran Hari ◽  
Brian Ung ◽  
Safiya Abouzaid ◽  
Amit Agarwal ◽  
Kejal Parikh
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Real World ◽  
Newly Diagnosed ◽  
Post Transplantation ◽  
Hematopoietic Stem

Aim: To compare real-world outcomes and costs among patients with newly diagnosed multiple myeloma receiving lenalidomide-only maintenance (Len-Mt) versus no maintenance after autologous hematopoietic stem cell transplantation. Patients & methods: Time to next treatment (TTNT) was evaluated; costs were calculated for 0–12, 12–24 and 24–36 months postindex date. Results: Len-Mt cohort had longer TTNT (HR: 0.43; p < 0.0001). Per-patient per-month costs during months 0–12 were higher among patients, receiving Len-Mt (USD 13,095 vs USD 8910; p < 0.0001), due to higher pharmacy costs – outpatient costs were lower. During months 12–24 and 24–36, outpatient costs were similar in both cohorts; total and pharmacy costs remained elevated for patients receiving Len-Mt. Conclusion: Len-Mt improved TTNT, initially reduced outpatient costs, but resulted in higher overall and pharmacy costs.

scholarly journals Allogeneic Hematopoietic Stem Cell Transplantation for Multiple Myeloma: Evolution and Outcomes over More Than Two Decades within EBMT Centers

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2554-2554 ◽  
Author(s):  
Mauricette Michallet ◽  
Mohamad Sobh ◽  
Simona Iacobelli ◽  
Anja van Biezen ◽  
Peter Dreger ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Group 2

Abstract Background: Autologous stem cell transplantation and the development of new agents with potent anti-tumor activity have considerably improved the survival of multiple myeloma (MM) patients. However, there is still a high risk of relapse mainly due to the inability of these agents to cure and eliminate definitively the MM cells. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment particularly for patients with high risk factors but its use is still controversial. We recently demonstrated in a prospective study that long-term outcome in MM patients was better with auto/RIC-allo as compared with auto-HSCT alone (Gahrton et al. , Blood 2013). The debate is still ongoing concerning the best time to propose allogeneic transplantation for MM patients; while there is agreement in the scientific community to perform it preferentially within a clinical trial, the majority of patients in Europe are still treated outside of a clinical trial. The objective of this study is to describe the context of use of allo-HSCT for MM in Europe within EBMT centers over more than two decades with the evaluation of different outcomes. Material and methods: We included in this study a total of 7333 patients who received allo-HSCT between January 1990 and December 2012, 4539 (62%) males and 2794 (38%) females with a median age at allo-HSCT of 51 years (range: 18-78), of which 4726 (64%) have been transplanted after year 2004. We identified 6 groups in this population, patients who received allo-HSCT upfront after induction therapy (Group 1, N=1934), patients who received allo-HSCT maximum 8 months after single auto-HSCT (Group 2, N=1997), patients who received allo-HSCT later than 8 months after single auto-HSCT (Group 3, N=1588), patients who received allo-HSCT maximum 8 months after double auto-HSCT (Group 4, N=588), patients who received allo-HSCT later than 8 months after double auto-HSCT (Group 5, N=930), and finally patients who received allo-HSCT after having received at least 3 different HSCT (Group 6, N=296). The different patient, disease and transplantation characteristics according to each group are detailed in the table. Results: The upfront use of allo-HSCT was seen to decrease after year 2000 to represent 12% of allo-HSCT performed in 2012 while the peak of allo-HSCT use directly after 1 auto-HSCT (within 8 months) was around year 2004 to attend 19% of usage in 2012. Remarkably, allo-HSCT was moreover used at the highest rate during the last years later than 8 months after single auto-HSCT which could be translated in a context of relapse post- first auto-HSCT to reach 33% of usage in 2012. The usage according to groups 4, 5 and 6 was 14%, 17% and 5% in 2012 respectively (Figure). The median overall survival (OS) for groups 1, 2, 3, 4, 5 and 6 was 33, 69, 25, 25, 23 and 15 months respectively with a 5 years OS probability of 39%, 53%, 33%, 31%, 29% and 23% respectively; the median progression-free survival (PFS) was 45, 39, 21, 22, 21 and 13 months respectively with a 5 years PFS probability of 43%, 42%, 26%, 28%, 24%, and 15% respectively. The cumulative incidence of transplant-related mortality for the 6 groups at 3 years was 36%, 20%, 32%, 33%, 36% and 35% respectively. The use of reduced intensity conditioning was associated with a significantly better OS only in group 2 compared to myeloablative conditioning with a median OS of 76 months versus 45 months (p=0.002) respectively. Year of transplantation before or after 2004 did not influence on outcomes. Conclusion: This large retrospective study shows different ways of using allo-HSCT for MM in Europe over a defined time period, it describes the different expected outcomes in each case. Allo-HSCT has not found its place yet in the treatment course of MM patients and the debate should continue based on advantages and disadvantages showed for each group of patients. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Tandem Autologous Hematopoietic Stem Cell Transplantation in Very Young Patients with Multiple Myeloma

2020 ◽  
Vol 09 (04) ◽  
pp. 233-235
Author(s):  
Rahul Naithani ◽  
Nitin Dayal ◽  
Reeta Rai
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Young Patients ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Platelet Recovery

Abstract Introduction Multiple myeloma (MM) in very young patients is uncommon, and no treatment guidelines exist for these patients. Patients and Methods We performed a retrospective analysis of five very young myeloma patients who underwent tandem autologous hematopoietic stem cell transplantation (HSCT). Results The median age was 37 years (range = 34–40 years). A median of two leukapheresis was performed (range = 1–4). The median number of hematopoietic stem cells collected was 5.4 × 106/kg (4.4–8.2 × 106/kg). During first transplant, four patients received melphalan of 200 mg/m2 and one patient received melphalan of 140 mg/m2 (due to renal failure) as conditioning regimen. Second transplant conditioning was melphalan of 200 mg/m2 for one patient and melphalan of 140 mg/m2 for remaining four patients. Two patients were in complete remission, and two were in very good partial remission and one patient progressed to active disease at the time of tandem autologous bone marrow transplant. All patients developed significant mucositis. Neutrophil and platelet recovery was longer in tandem autologous hematopoietic stem cell transplant. More viral infections were seen in tandem transplant. Day 30 and day 100 mortality was nil. Conclusion We present data on tandem autologous HSCTs in very young patients with MM in India. Responses continued to improve in this small series.

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