Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma Patients with Renal Insufficiency: a Single Centre Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4362-4362
Author(s):  
Malgorzata Krawczyk-Kulis ◽  
Slawomira Kyrcz-Krzemien ◽  
Tomasz Czerw ◽  
Monika Zielinska ◽  
Grazyna Bober
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Stem Cell ◽  
Renal Insufficiency ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Regeneration Time ◽  
Ckd Stage ◽  
Stem Cell Collection

Abstract Abstract 4362 BACKGROUND AND AIMS Multiple myeloma (MM) might be a cause a of the malignancy-related renal insufficiency, often present at diagnosis. Severity of it implicates further therapy. Patients with severe renal failure are generally excluded from high dose therapy even though they display a poor prognosis with conventional chemotherapy regimens. The goal of this study was to evaluate the eligibility and efficacy of autologous hematopoietic stem cell transplantation (AHCT) in MM patients with concomitant renal insufficiency. 239 MM patients were treated in our department with high-dose chemotherapy followed by AHCT between 1993 and 2009. Twenty of them (8%) were also diagnosed with renal impairment. PATIENTS AND METHODS 20 patients (8 women, 12 men), age 40-65 years (median 51) were enrolled. MM subtype at diagnosis was: IgG, n=14 (kappa-9, lambda-5); IgA kappa, n=1; light chain disease (LCD), n=4 (kappa-3, lambda-1); non-secretory, n=1. Chronic kidney disease (CKD) stage at MM diagnosis was 2-5 (median 3). One pt. was on chronic hemodialysis, two required plasmapheresis. Before AHCT pts. were treated with 1-4 (1) regimens, mainly VAD and CTD. 8/20 pts. received radiotherapy. Mobilization regimen was high-dose cyclophosphamide in 8 and IVE (iphosphamide, etoposide, epirubicin) in 12 cases. Stem cell collection yield was effective in all pts. (median 17.6 (1.9 - 44.7) x 10e6 CD34+ cells/kg). Disease stage at AHSCT: CR n=6, VGPR n=2, PR n=12. RESULTS Renal function measured before transplantation significantly improved due to MM treatment compared to that at diagnosis, p=0.008. CKD stage before transplantation equaled 1-4 (median 2). The only one patient who initially required hemodialysis became dialysis independent before AHCT. Conditioning regimen with melphalan (range 75-200mg/m2) was generally well tolerated. The median numbers of transplanted cells were following: NC 2.5 (1-7.6) x10e8/kg; CD34+ 7.9 (0.8-21.7) x 10e6/kg. All patients engrafted. Median regeneration time of granulocytes up to >0.5 G/l and of platelets to >50 G/l equaled 14 (12-19) and 14 (12-101) days, respectively. Transplant related mortality at day 100 was 0%. Mucositis, diarrhoea, bacterial and HSV infections were main complications after AHCT. Regeneration time, hospital stay, days of intravenous antibiotics or antifungal drugs administration and number of transfusion were comparable to pts. transplanted without renal impairment. No renal complications were observed. On the contrary creatinine clearance after transplantation showed trend towards further improvement compared to that before AHCT, p=0.07. The probability of overall (OS) and progression free (PFS) survival for studied group of pts. were 84% and 63%, respectively. Median observation time 2.3 years (0.1-12.5). CONCLUSIONS Our observation demonstrates that AHCT is an effective and well tolerated option for MM patients with mild or moderate renal insufficiency. Treatment before transplantation and also high-dose chemotherapy followed by AHCT may even improve renal function. No relationship between CKD and stem cell collection yield, engraftment or severity of post-transplant complications was observed in this group of patients. Disclosures: No relevant conflicts of interest to declare.

Reapplication of High-Dose Chemotherapy with Melphalan Followed by Autologous Hematopoietic Stem Cell Transplantation as Salvage Therapy for Patients with Relapsed Multiple Myeloma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3568-3568
Author(s):  
Leopold Sellner ◽  
Sonja Teodorov ◽  
Christiane Heiss ◽  
Axel Benner ◽  
Gerlinde Egerer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Transplantation ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Time To Progression ◽  
Hematopoietic Stem ◽  
One Year

Abstract Abstract 3568 Introduction: High dose chemotherapy with melphalan followed by autologous peripheral blood stem cell transplantation (PBSCT) is a standard treatment regimen for young patients with multiple myeloma. However, there are few studies, mainly with low patient counts, testing the benefit of the reapplication of high dose chemo therapy in relapsed or refractory myeloma. Methods: Here we retrospectively analyzed 178 patients (56% male, 44% female, median age 60 years) with relapsed or refractory myeloma who were treated by reapplying high dose chemotherapy with melphalan followed by autologous PBSCT in our institution over the last 18 years. The median follow up of this study was 54 months. Result: Median progression free survival (PFS) and overall survival (OS) after relapse autologous transplantation were 16 and 35 months, respectively. 66% of the patients received newer antimyeloma agents for reinduction therapy (39% thalidomide, 6% bortezomib, 21% lenalidomide). In univariate analysis, time between first transplantation and progression of disease had a significant impact on PFS and OS (p=0.001 and p<0.001). Estimated hazard ratio (HR) for prolongation of time to progression (TTP) after first transplantation of one year for PFS and OS are 0.85 and 0.73, respectively. The effect of TTP after first PBSCT on PFS and OS with respect to different clinically relevant cutoff values is illustrated in Table 1. Conclusion: Reapplication of high dose chemotherapy can be an effective treatment option for relapsed or refractory myeloma, in particular in patients with a time to progression after first autologous transplantation of more than one year. Disclosures: No relevant conflicts of interest to declare.

NON-Cryopreserved Hematopoietic STEM CELL Transplantation in Multiple Myeloma. a Single Center Experience in Oran (ALGERIA)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1990-1990
Author(s):  
Amine MA Bekadja ◽  
Souad ST Talhi ◽  
Hafida OH Ouldjeriouat ◽  
Osmani OS Soufi ◽  
Mohamed BM Brahimi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem

Abstract Introduction: For younger patients under 65 years of age, induction followed by high-dose chemotherapy with autologous stem cell transplantation (ASCT) is the standard treatment in multiple myeloma (MM). There is limited experience with non-cryopreserved autologous hematopoietic stem cell transplantation. We evaluated the efficacy and safety of non-cryopreserved storage of ASCT in patients undergoing ASCT for MM. Patients and methods: Autologous stem cell was mobilized using G-CSF alone (10 µg/kg/day for 5 days). Leukapheresis to harvest stem cells were performed on day -2 and -1. The grafts were kept in a conventional blood bank refrigerator at +4°C until reinfusion on day 0. The conditioning regimen consisted of melphalan 200 mg/m2 in all patients. Results: From May 2009 to December 2013, 134 patients with MM were treated in our center in Oran. The median age at ASCT was 55 years (range; 27-67). There were 80 males and 54 females. The median harvested CD34+ cell count was 3,5x106/kg (range; 1, 22 to 13, 24). All patients had engraftment on the median of day 10 (range; 7 to 17) and platelet transfusion independence on the median of day 13 (range; 9 to 24). There was no graft failure. Mucositis grade 3/4 was seen in 68% patients. Transplant related mortality at 100 days was 2.9%. The overall response to transplant was 92%. In the 130 evaluable patients, the median post-transplant overall survival had not been reached. The estimated overall survival at 75 months was 63% with 95% confidence interval and the median post-transplant disease free Survival was 35 months (0.05%). 93 (72%) patients are alive and 75 (81%) without disease activity after a median follow-up of 35 months (range; 3 to 75). Discussion: We conclude that high dose chemotherapy and autologous transplant with non cryopreserved ASCT is a simple, effective and safe method for MM with equivalent results, and that cryopreservation is not necessary in the treatment of MM under our work conditions in developing countries Disclosures No relevant conflicts of interest to declare.

Utilization and outcomes of high-dose chemotherapy and stem-cell rescue in patient with testicular cancer from 2005 to 2014 in United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18246-e18246
Author(s):  
Aakash Desai ◽  
Devashish Desai ◽  
Pushti Khandwala ◽  
Smith Giri ◽  
Leonard Joseph Appleman ◽  
...  
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Testicular Cancer ◽  
High Dose Chemotherapy ◽  
Matched Pair ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Stem Cell Rescue ◽  
Matched Pair Analysis

e18246 Background: Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue. This regimen is commonly used as salvage therapy, third-line or later therapy in patients with platinum-refractory disease. The utilization and real-world outcomes and complications of patients with testicular cancer undergoing autologous hematopoietic stem cell transplant (aHSCT) in United States are unknown. Methods: We queried National Inpatient Sample, a large inpatient data set in the United States, from 2005 to 2014 for male patients with testicular cancer or multiple myeloma (control group) receiving aHSCT and compared outcomes between these groups. The primary outcome was in-hospital mortality rate, and the secondary outcomes included in-hospital complications of aHSCT, length of stay and total charges. Outcomes were assessed by means of univariate analysis, multivariate regression and propensity score matched-pair analysis. Results: A total of 391 patients (weighted N = 1,909) with testicular cancer and 4,809 male patients (weighted N = 23,501) with multiple myeloma who underwent aHSCT from 2005 to 2014 were identified. Mean age of patients with testicular cancer was 32.3 years vs 59 years for multiple myeloma patients (p < 0.001) There were no differences in in-hospital mortality rates (1.5% vs 1.4%, p = 0.85) or rates of intubation (2.3% vs 1.6%, p = 0.36), sepsis (7.7% vs 7.5%, p = 0.94), bacteremia (13.5% vs 15.6%, p = 0.42), or stomatitis (43.8% vs 38.8%, p = 0.87) between patients with testicular cancer and multiple myeloma receiving autologous HSCT. However, utilization of total parenteral nutrition was higher in patients with testicular cancer (12.9% vs 4.7%, p < 0.001). There was no difference in length of stay (17.5 vs 17.5 days, p = 0.77) and total charges (121,120$ vs 123,729$, p = 0.74) between two groups. The results were consistent in multivariate and propensity score matched-pair analysis. Conclusions: The in-hospital outcomes of patients with testicular cancer receiving aHSCT appears to be similar to patients with multiple myeloma. However, overall utilization of aHSCT for testicular cancer appears to be low in United States.

Influence of First-Line Regimens on the Outcomes of High-Dose Chemotherapy with Autologous Hematopoietic Stem-Cell Transplantation for Patients with Newly Diagnosed Multiple Myeloma.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 931-931 ◽  
Author(s):  
Bimalangshu R. Dey ◽  
Benjamin Cox ◽  
A. Jo Chien ◽  
Martin Caron ◽  
Steven L. McAfee ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Newly Diagnosed ◽  
First Line ◽  
Conventional Chemotherapy ◽  
Hematopoietic Stem ◽  
Group 2 ◽  
Group 1

Abstract Randomized trials that incorporated high-dose chemotherapy (HDC) plus autologous hematopoietic stem-cell transplantation (Au-HSCT) into the early treatment of patients with newly diagnosed multiple myeloma demonstrated superior overall and event-free survival (EFS) in patients 65 years of age or younger, who received Au-HSCT, as compared with patients who received conventional chemotherapy. Based on these encouraging results, Au-HSCT is recommended for patients with myeloma as part of their initial treatment, and today, myeloma is the most common indication for HSCT in the world. All patients in these trials received four to six months of conventional chemotherapy prior to HDC and Au-HSCT. In practice, however, both in the community as well as in academic hospitals, patients are undergoing Au-HSCT after being treated with various first-line regimens, including chemotherapeutics, high-dose dexamethasone (HDex), immunomodulatory drugs such as thalidomide and recently, proteasome inhibitors. In this retrospective study, we examined the impact of first-line therapy on the outcomes following Au-HSCT. Our objective was to compare two treatment groups - chemotherapy versus non-chemotherapy, prior to Au-HSCT - with respect to survival after Au-HSCT. Between 1997 and 2004, 37 previously untreated evaluable patients with myeloma, received either chemotherapy (group 1, n=25; vincristine, adriamycin and dexamethasone (VAD), n=24; melphalan and prednisone (MP), n=1) or non-chemotherapy regimens (group 2, n=12; HDex, n=9; thalidomide plus HDex, n=3), then received HDC followed by cyclophosphamide plus granulocyte colony stimulating factor-mobilized HSCT. The median age of patients in group 1 was 58 (range, 44–73) years and in group 2 was 55 (range, 41–67) years; 22 patients in group 1 (88%) and 10 patients in group 2 (83%) had stage III disease; the median times from diagnosis to HSCT were 6 (range, 5–16) and 8 (range, 5–25) months, respectively, in groups 1 and 2. The rates of complete and near-complete response were 44% in group 1 and 42% in group 2; the rates of partial responses were also similar: 48% and 42% respectively. The median duration of EFS was 31 (range, 7–89) months, and the median overall survival (OS) was 55 (range, 12–98) months in group 1, as compared with group 2 where EFS and OS were 21 (range, 12–40) and 31 (range, 16–76) months, respectively. The EFS at 3 years was 44% in group 1 and 25% in group 2, and OS at 5 years was 32% in group 1 and 8% in group 2 (statistically not significant). In conclusion, patients with newly diagnosed myeloma, when treated with chemotherapy prior to Au-HSCT, may have long-term overall and EFS advantages, as compared with patients who are treated with first-line non-chemotherapy regimens. The reasons for the longer duration of response in the chemotherapy group despite similar response rates in the two groups are unknown, but may be due to more effective suppression of residual disease or non-specific damage to the marrow microenvironment, which is necessary for the growth of myeloma cells. Although, the difference in survival outcomes following Au-HSCT between the two groups did not achieve statistical significance, our results raise an important question regarding the “adequacy” of different first-line regimens prior to Au-HSCT, and therefore, justify the need for prospective randomized studies to evaluate optimal pre-AuHSCT induction therapy.

Impact of Non High-Risk Chromosomal Abnormalities on the Outcome of Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 333-333 ◽  
Author(s):  
Sairah Ahmed ◽  
Heather Lin ◽  
Veera Baladandayuthapani ◽  
Mubeen A Khan ◽  
Gary Lu ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Chromosomal Abnormalities ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem

Abstract Abstract 333 Impact of Non High-Risk Chromosomal Abnormalities on the Outcome of Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma Background: Despite novel therapeutic agents and high-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HCT), most patients eventually progress and die of their disease. Recent advances in cytogenetic, molecular and genomic studies have led to identification of several chromosomal and molecular abnormalities. These abnormalities are important predictors of response to therapy, progression-free survival (PFS) and overall survival (OS). On conventional cytogenetic (CC) analyses, del 13, t(4;14), t(14;16) and del 17p are considered high-risk (HR). On Fluorescence in situ hybridization (FISH) analysis, all except del 13 are considered HR (Munshi, N et al. Blood 2011 117: 4696–4700). However there are a number of chromosomal abnormalities whose significance is not clearly identified (non-HR). In this study we report the impact of these non-HR chromosomal abnormalities on the outcome of patients who received high-dose chemotherapy and auto-HCT. Methods: We performed a retrospective review of patients with multiple myeloma who underwent high dose chemotherapy followed by auto-HCT at the M.D. Anderson Cancer Center. Between 10/1991 and 12/2010, 1570 patients received auto-HCT. The results of CC studies were available for 1329 patients, either at diagnosis or at relapse, but before auto-HCT. The primary objective was to study the impact of non-HR chromosomal abnormalities on PFS and OS, and to compare them to patients without chromosomal abnormalities. Results: Patient characteristics and major outcomes are summarized in the attached Table. In 1329 patients with available CC analyses before auto-HCT, chromosomal abnormalities were identified in 405 (30%) patients. One-hundred and seven (7%) patients had known HR chromosomal abnormalities, while 298 (23%) patients had non-HR chromosomal abnormalities. Fifty (17%) patients with non-HR chromosomal abnormalities and 296 patients (32%) with normal CC achieved complete or stringent complete responses (CR + sCR) (p=0.0001). Median follow up in surviving patients was 36 months. Median PFS in patients with non-HR chromosomal abnormalities and normal CC were 18.2 months (95%CI: 16–22.7) and 32.7 months (95% CI: 27.8–36.3), respectively (p= <.0001) (Figure 1). The OS in patients with non-HR chromosomal abnormalities and with normal CC were 56.5 months (95% CI: 43.2–66.9) and 87.2 months (95%CI: 80.1–102.4), respectively (p= <.0001) (Figure 2). Conclusions: In this large single center study with a long follow up, we demonstrated that non-HR chromosomal abnormalities in myeloma are associated with a lower CR rate and shorter PFS and OS after auto-HCT. Further studies are needed to better define these non-HR abnormalities and their impact on prognosis. Disclosures: No relevant conflicts of interest to declare.

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