Type of Relapse in 91 Newly Diagnosed MM Patients Treated with High Dose Chemotherapy Followed by Autologous Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5451-5451
Author(s):  
Maria Teresa Petrucci ◽  
Giuseppe Avvisati ◽  
Ombretta Annibali ◽  
Saveria Capria ◽  
Maria S. De Propris ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Plasma Cells ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Newly Diagnosed ◽  
Extramedullary Relapse

Abstract High dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) is now considered standard therapy in patients (pts) with Multiple Myeloma (MM) aged less than 65–70 years. Using this therapeutic approach, newly diagnosed MM pts may achieve a complete remission rate of 30–50% associated to prolonged disease-free and overall survival (OS) rates. Unfortunately, HDT followed by ASCT is not curative and only a small fraction of pts remains free of disease after a long follow-up. In this study we analysed the different patterns of relapse after HDT and ASCT in 91 previously untreated MM pts (M/F : 46/45; median age: 54 years, range 32 – 69). As for stage, according to Durie and Salmon criteria, 4 pts (4%) were stage IA, 26 (29%) IIA, 57 (63%) IIIA and 4 (4%) were stage IIIB. The monoclonal component (MC) was: IgG in 54 pts (60%), IgA in 23 pts (25%), IgD in 2 pts (2%); 11 pts (12%) had a micromolecular MM (k/l were 8/3). Only one patient had a non-secretory MM. Median bone marrow plasma cells were 43%. Of the 91 pts, 5 were not evaluable for response because had died early during the transplantation procedure. Causes of death were: hepatic toxicity (1 patient), cardiac complications (1 patient) and hemorrhagic complications (3 pts). Of the remaining 86 evaluable pts, 84 (98%) achieved an objective response and 2 (2%) showed a progressive extramedullary disease (cutaneous and thoracic). After a median follow-up of 49 months (range 6–169) from the HDT-ASCT, 45/84 (54%) responding pts have relapsed and 38/84 (46%) are still alive and responding, the remaining patient was lost to follow-up and considered as event in both OS and event free survival (EFS) curves. The relapse type was “classical” (bone marrow + increase in MC) in 34 (75%) pts, extramedullary in 8 (18%) pts and of both type in 3 (7%) pts. Extramedullary relapse was defined by the presence of normal bone marrow, no increase in MC and presence of plasma cell tumour masses outside the bone marrow demonstrated by clinical examination, imaging and histology. As of July 31 2006, the median OS was not yet reached with 66% of pts still alive. The median overall EFS and time to progression (TTP) were: 82 and 89 months, respectively. As for the 34 pts with “classical” relapse and the 8 pts with extramedullary relapse, median OS and EFS were 120 and 29 months versus not reached and 85 months, respectively. The median time from HDT-ASCT to extramedullary relapse was 85 months. Sites of extramedullary relapse included vertebral and para-vertebral localization (7 pts), humeral localization (2 pts) and thoracic localization (1 patient); one patient presented humeral and pancreatic localization. The 8 pts with isolated extramedullary relapses were treated by local radiotherapy (4 pts), radiotherapy combined to Melphalan-Prednisone (MP) (3 pts) and a combination of surgical treatment + MP (1 patient). In conclusion, HDT-ASCT has greatly improved the prognosis of MM pts, however about 10%–15% of transplanted pts experience an extramedullary relapse probably due to sub-clinical seeding of tumor cells suggestive of the presence of an extramedullary clone of plasma cells with a high degree of chemo resistance responding, however, to radiotherapy.

Bortezomib-Based Induction Therapy Followed by High-Dose Chemotherapy and Autologous Stem Cell transplantation in Newly-Diagnosed Myeloma: Initial Report From a Chinese Multiple-Center Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4557-4557
Author(s):  
Jiong Hu ◽  
Zhi-Xiang Shen
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Prospective Study ◽  
Autologous Stem Cell Transplantation ◽  
Chinese Population ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Line Treatment ◽  
Newly Diagnosed

Abstract Abstract 4557 Bortezomib-based induction therapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT) is considered as standard treatment for patients with newly-diagnosed myeloma. Though front-line treatment of Bortezomib containing regimen is widely used in China, first-line treatment of high-dose chemotherapy with ASCT is not widely accepted for Chinese patients. There is also no prospective study in Chinese population to evaluate the efficacy, safety and feasibility of such treatment strategy. This is a prospective study in young Chinese population (18–65 year old) with newly-diagnosed myeloma (NCT00984828). All patients will receive 4 cycles of Bortezomib and Dexamethasone as frontline therapy. After that, patients will receive either a single ASCT conditioning with melphalan 200mg/m2 (mel 200) or ASCT with mel 200 + bortezomib conditioning and another 3 cycles of Bortezomib monotherapy as consolidation after ASCT. From Jan 2010, a total of 37 patients (median age 54, 31∼64) were enrolled in this study. There were 2 patients died of treatment toxicity 1 and 3 months after entering study. In the remaining 35 patients, 17 already finished ASCT and other 18 patients declined the ASCT. In 23 evaluable patients, 11 achieved CR (n=10) and VGPR (n=1), 9 with PR, 2 with SD and 1 PD. At the last follow-up at May 2012, a total of 6 patients experienced disease progression and no patients died of disease or treatment associated toxicity. As a whole group, with a median follow-up of 10 months (1∼33 months), the estimated 2-year OS and PFS were 94.3±4% and 66.2±12.3% respectively. Though further analysis was impossible with limited number of patient enrolled in the study with short follow-up, overall, the treatment was safe particularly no significant treatment associated toxicity or treatment mortality documented during and after ASCT procedure. The overall 43% CR rate was comparable to most previous reports. The early analysis of the study demonstrated that Bortezomib-Dexa followed by ASCT can be safely performed in Chinese population and further enrolled and follow-up may provide evidence of long-term efficacy of such strategy in Chinese population. Disclosures: No relevant conflicts of interest to declare.

Therapy-related acute myeloid leukemia and myelodysplasia after high-dose chemotherapy and autologous stem cell transplantation

Blood ◽  
2000 ◽  
Vol 95 (11) ◽  
pp. 3273-3279 ◽  
Author(s):  
Jens Pedersen-Bjergaard ◽  
Mette Klarskov Andersen ◽  
Debes H. Christiansen
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cd34 Cells ◽  
Acute Myeloid

Abstract Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCT) for malignant diseases have become an important problem. The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age and previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors. In 3 studies, patients transplanted with CD34+ cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34+ cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7. The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration.

Outcomes of High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in Stage IIIB Inflammatory Breast Cancer

1999 ◽  
Vol 17 (7) ◽  
pp. 2006-2006 ◽  
Author(s):  
D. Adkins ◽  
R. Brown ◽  
K. Trinkaus ◽  
R. Maziarz ◽  
S. Luedke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
High Dose Chemotherapy ◽  
Stage Iiib ◽  
High Dose ◽  
Er Positive

PURPOSE: To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation. PATIENTS AND METHODS: Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation, and 41 patients received locoregional radiation therapy. Tamoxifen was prescribed to patients with estrogen receptor (ER)–positive cancer. RESULTS: The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariate analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P = .04) and receipt of tamoxifen (P = .06); however, the benefit of tamoxifen was only demonstrated in patients with ER-positive breast cancer. At last follow-up, 28 patients (59.6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast cancer. Seventeen patients died: 15 from disease recurrence and two (4.2%) from treatment-related mortality due to HDCT. CONCLUSION: In this analysis, the early results of treatment with CMT and HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.

Therapy-related acute myeloid leukemia and myelodysplasia after high-dose chemotherapy and autologous stem cell transplantation

Blood ◽  
2000 ◽  
Vol 95 (11) ◽  
pp. 3273-3279
Author(s):  
Jens Pedersen-Bjergaard ◽  
Mette Klarskov Andersen ◽  
Debes H. Christiansen
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cd34 Cells ◽  
Acute Myeloid

Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCT) for malignant diseases have become an important problem. The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age and previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors. In 3 studies, patients transplanted with CD34+ cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34+ cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7. The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration.

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