Autologous Stem Cell Transplantation for Multiple Myeloma in Patients over 70 Years: A Matched Comparison with Patients under 65 Years.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1173-1173
Author(s):  
Shaji Kumar ◽  
Martha Lacy ◽  
Angela Dispenzieri ◽  
Suzzane Hayman ◽  
William Hogan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Older Patients ◽  
Control Group ◽  
High Dose ◽  
High Dose Therapy ◽  
Younger Patients ◽  
Dose Therapy

Abstract Background: High dose therapy with autologous stem cell rescue has been shown to prolong survival in patients with multiple myeloma in randomized controlled trials. However, most of the prospective studies have included younger patients, usually 65 or less. It is important to have a better understanding of the outcome of transplantation in the older patients given the median age of onset of myeloma of 65 years. We retrospectively reviewed our institutions experience with high dose therapy for patients over 70 years. Methods: We identified 35 patients with multiple myeloma, from the transplant database, who were at or over the age of 70 at the time of their high dose therapy. We matched these patients to 70 patients (two matches for each patient), based on stage at transplant (primary refractory, plateau phase, relapse off therapy, or relapse on therapy), Durie Salmon stage, high or low labeling index, conventional cytogenetics (abnormal vs normal), presence or absence of circulating plasma cells at time of transplant, and whether cyclophosphamide was used as part of mobilization in that order of priority. Results: The median age of the two groups were 55.3 (Range 37.3–64.8) and 71.7 (Range 70–75.8) years at the time of transplant. The median time to transplant from diagnosis was similar (6.4 for the older patients compared to 6.9 months for the other, P = NS). Ten of the 35 older patients received reduced dose melphalan (140 mg/2)) compared to 3 patients in the control group; P < 0.01. The median follow up from transplant was 10.1 months for the older patients compared to 18 months for the control group. The overall response rate was similar for the two groups (97.1% for the older patients compared to 95.5 for the control group). Eleven (31%) of the older patients and 17 (24%) of the control patients achieved a CR (P = NS). The post transplant progression free survival estimate at 1 year post transplant was 65.3% for the older patients compared to 66% for the control group (P = 0.3)The two year estimated overall survival from transplant was similar in the two groups; 58% for the older patients compared to 67% for the control group. The overall survival from diagnosis was similar for the two groups (P = 0.6). The median number of days hospitalized was 9 days for the older population compared to 5 days for the control group (P = 0.37). Four patients died within the first one hundred days, one (3%) among the older patient group and 3 (4.3%) in the control group. Conclusions: High dose therapy and autologous stem cell transplantation is feasible in selected patients with multiple myeloma over 70 years. It is likely that these older patients were selected based on their overall performance status, a factor that is difficult to analyze in this retrospective review. Nearly 70% of the elderly patients received full dose melphalan for conditioning (200 mg/m2). The toxicity of transplant as well as the outcome appears to be very similar to the younger patients. Patients with multiple myeloma should not be excluded from high dose therapy solely on the basis of their chronological age.

scholarly journals The role of high-dose therapy and autologous stem cell transplantation in the treatment of patients with multiple myeloma

2017 ◽  
Vol 70 (suppl. 1) ◽  
pp. 51-55
Author(s):  
Jelena Bila ◽  
Jelena Jelicic ◽  
Milena Todorovic-Balint ◽  
Darko Antic ◽  
Dragana Vujic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Treatment Approach ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy

Introduction. Limited efficacy of standard chemotherapy initiated the introduction of high-dose therapy followed by autologous stem cell transplantation in the treatment of patients with multiple myeloma. The aim of the study was to analyse results of treatment with high-dose therapy followed by autologous stem cell transplantation in 110 newly diagnosed multiple myeloma patients during the period May 2015 - January 2016. Material and Methods. Patient group consisted of 51 female and 59 male patients with average age of 57 years. Most of the patients were diagnosed with IgG myeloma (58.2%) and clinical stage III (74.5%, Salmon&Durie). Renal impairment initially existed in 26 patients. By 2008, patients were treated with 4-6 cycles of induction chemotherapy according to the protocol VAD (33 patients, 30%); and afterward according to the CTD protocol (72 patients, 65.5%). Mobilization of the stem cell was performed according to the protocol CAD followed by granulocyte colony-stimulating factor 5-10 ?g/kg body weight/day starting on day 9, until the apheresis around day 14 of mobilization (? 1-2 days). Within 4-8 weeks after mobilization, HDT with Melphalan 200 mg/m2 accompanied with autologous stem cell transplantation was performed. Results. Applied induction treatment resulted in the achievement of at least partial remission in 80% patients. The average number of CD34+ in the product of apheresis was 8.1x106/kgBW, while during HDT with autologous stem cell transplantation, median was 4x106/kg body weight CD34+ cells. Average recovery was registered around +15 days after autologous stem cell transplantation, characterized by a minimal number of febrile days (median 2 days, range 0-10 days). In 95% patients, partial remission was recorded +100 days after autologous stem cell transplantation with average duration of 45 months, and achievement of complete remission in 29% pts with median overall survival of 100 months. This treatment approach resulted in overall survival longer than 45 months in more than 90% patients. The factors found to affect the duration of remission and overall survival are: ISS score ?2. Conclusion. High-dose therapy followed by autologous stem cell transplantation is an efficient and safe treatment approach to multiple myeloma patients. Along with biological characteristics of the disease, complete remission achievement after such treatment is of essential significance for the course and outcome of multiple myeloma patients.

Stem Cell Transplantation (SCT) Improves Survival in Acute Biphenotypic (ABL) and Acute Undifferentiated Leukemia (AUL): A Single Centre Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1093-1093
Author(s):  
Sujaatha Narayanan ◽  
Michael J. Barnett ◽  
Yasser R. Abou Mourad ◽  
Donna L. Forrest ◽  
Donna E. Hogge ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Standard Dose ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy

Background: ABL and AUL are associated with an unfavourable outcome for patients (pts) treated with standard-dose therapy alone. Although high-dose therapy has been used successfully in this population, the optimal management of pts with ABL/AUL remains unclear. Methods: A retrospective review was performed involving 24 adult pts with ABL or AUL who were treated in Vancouver between 1984 and 2006. Kaplan-Meier estimates were utilized for event-free survival (EFS) and overall survival (OAS) and a multivariate analysis was performed to determine factors predictive of outcome. Characteristics: Utilizing the WHO criteria, 18 pts had ABL and 6 pts had AUL. There were 17 males and 7 females with a median age of 37 (range 22–75) years. Median white cell count (WCC) at presentation was 10.1 × 109(range: 0.9–196 × 109)/L. Seven pts had poor-risk karyotypes (3 pts complex, 3 pts with t(9,22), 2 pts with11q23 rearrangement, and 1 pt with monosomy 7),12 pts had standard-risk karyotypes, and 5 pts had an unknown karyotype. Induction chemotherapy consisted of Cytosine arabinoside (3–6/m2/day), Daunorubicin, Vincristine and Prednisone with one pt with t(9,22) also having received Imatinib Mesylate. Thirteen pts went on to receive high-dose therapy and SCT. Stem cell source was autologous in 3 pts (all with AUL) or a related (6 pts) or an unrelated donor (4 pts). Eight of 10 pts were in complete remission at the time of SCT, one was in relapse and one had primary refractory ABL. Conditioning was TBI-based in 10 pts and Busulfan-based in 3 pts. Results: EFS and OAS estimates for all 24 patients at 3 years were 25% (95% CI 13%–50%) and 32% (95% CI 17%–58%), respectively. The non-relapse mortality (NRM) for the whole group at 3 years was 43% (95%CI 15%–61%). On multivariate analysis, when compared to pts receiving only standard-dose chemotherapy, pts who underwent high-dose therapy had significantly improved EFS [39% (95% CI 19%–77%) vs. 9% (95% CI 1%–59%), p=.03] and OAS [46% (95% CI 26%–83%) vs.14% (95% CI 3–74%), p=0.01], respectively. Age, WCC at presentation and cytogenetic risk group were not found to significantly influence outcome. Conclusion: Although patient numbers are limited, this experience would suggest that patients with ABL/AUL who achieve complete remission with standard chemotherapy should be considered for high-dose therapy and stem cell transplantation. This approach provides them with the greatest probability of long-term event- free and overall survival.

Achievement of at Least Very Good Partial Response Is a Simple and Robust Prognostic Factor in Patients With Multiple Myeloma Treated With High-Dose Therapy: Long-Term Analysis of the IFM 99-02 and 99-04 Trials

2009 ◽  
Vol 27 (34) ◽  
pp. 5720-5726 ◽  
Author(s):  
Jean-Luc Harousseau ◽  
Herve Avet-Loiseau ◽  
Michel Attal ◽  
Catherine Charbonnel ◽  
Frederic Garban ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Prognostic Factor ◽  
Partial Response ◽  
Stem Cell Transplantation ◽  
High Dose ◽  
Prognostic Impact ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Good Partial Response

Purpose The prognostic impact of complete response (CR) achievement in multiple myeloma (MM) has been shown mostly in the context of autologous stem-cell transplantation. Other levels of response have been defined because, even with high-dose therapy, CR is a relatively rare event. The purpose of this study was to analyze the prognostic impact of very good partial response (VGPR) in patients treated with high-dose therapy. Patients and Methods All patients were included in the Intergroupe Francophone du Myelome 99-02 and 99-04 trials and treated with vincristine, doxorubicin, and dexamethasone (VAD) induction therapy followed by double autologous stem-cell transplantation (ASCT). Best post-ASCT response assessment was available for 802 patients. Results With a median follow-up of 67 months, median event-free survival (EFS) and 5-year EFS were 42 months and 34%, respectively, for 405 patients who achieved at least VGPR after ASCT versus 32 months and 26% in 288 patients who achieved only partial remission (P = .005). Five-year overall survival (OS) was significantly superior in patients achieving at least VGPR (74% v 61% P = .0017). In multivariate analysis, achievement of less than VGPR was an independent factor predicting shorter EFS and OS. Response to VAD had no impact on EFS and OS. The impact of VGPR achievement on EFS and OS was significant in patients with International Staging System stages 2 to 3 and for patients with poor-risk cytogenetics t(4;14) or del(17p). Conclusion In the context of ASCT, achievement of at least VGPR is a simple prognostic factor that has importance in intermediate and high-risk MM and can be informative in more patients than CR.

Combined Use of Palifermin and Pegfilgrastim Significantly Reduces Toxicity of High-Dose Therapy and Autologous Blood Stem Cell Transplantation in Patients with Multiple Myeloma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5260-5260
Author(s):  
Guido Kobbe ◽  
Nadine Hieronimus ◽  
Thorsten Graef ◽  
Ingmar Bruns ◽  
Arcos Cibere ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Hematopoietic Reconstitution ◽  
Short Course ◽  
Combined Use

Abstract Background: The use of conventional G-CSF after high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) has resulted in earlier hematopoietic reconstitution in comparison to patients not receiving hematopoietic growth factors. We have shown that a single injection of 6mg Pegfilgrastim after ASCT results in sustained high G-CSF serum levels and fast hematopoietic reconstitution in patients with multiple myeloma (Fenk et al, Exp Hematol, in press). However, duration of hospitalisation and need for supportive care were only marginally improved by Pegfilgrastim. We therefore added a short-course of Palifermin, a recombinant human keratinocyte growth factor, before HDT to further reduce toxicity. Patients and Methods: So far 15 patients (the Pal-Peg-group, 8 male, 7 female, median age 59, range 45–73) with multiple myeloma received 3 daily injections of Palifermin (60ug/kg/d) before HDT. At least 24 hours after the last Palifermin dose patients were treated with high-dose melphalan (median dose 200mg/m2, range 100–200) followed by ASCT of a median of 3.5×10E6CD34+cells/kg (range 1.9–18.8). Pegfilgrastim (6mg) was given one day after blood stem cell infusion. This group of patients was compared to a previous cohort of 21 patients (the Peg-only-group, 9 male, 12 female, median age 57, range 39–69) with multiple myeloma who had received a median of 4.5×10E6CD34+cells/kg (range 2–12) and 6mg Pegfilgrastim after HD-melphalan conditioning but without Palifermin pretreatment. Patients in the Pal-Peg-group had more advanced disease. Results: Time to hematopoietic reconstitution was not significantly different in both groups with a median time to a WBC >1×10E9/l of 11 days (range 9–13) in the Pal-Peg-group and 10 days (median, range 9–14) in the Peg-only-group (p=ns). The same was true for platelet reconstitution. Due to a markedly reduced incidence and severity of mucositis in the Pal-Peg-group the duration of hospitalisation was significantly shorter (median 17 days, range 13–23 vs 21 days, range 15–34, p<0.05). In addition the need for iv antibiotics (median 0 days, range 0–9 vs 4 days, range 0–21), morphine (median 0 days, range 0–12 vs 4 days, range 0–21) and erythrocyte transfusions (median 0, range 0–4 vs 2, range 0–14) was significantly reduced (p<0.05 for all). Because some patients needed parenteral nutrition (PEN) for prolonged nausea the reduction in PEN was not significant so far (median 0 days, range 0–12 vs 6 days, 0–16, p=0.07) Conclusion: The combined use of a short course of Palifermin and Pegfilgrastim significantly reduces toxicity after HDT and ASCT in patients with multiple myeloma and improves patient convenience. As some patients still had severe mucositis further research should focus on predictive factors to identify patients who may benefit from an extended use of Palifermin before and after HDT.

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