Response Before Autologous Hematopoietic Stem Cell Transplantation Is An Important Predictor of Outcome in Multiple Myeloma,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4119-4119
Author(s):  
Shatha Farhan ◽  
Heather Lin ◽  
Veerabhadran Baladandayuthapani ◽  
Nina Shah ◽  
Qaiser Bashir ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Partial Response ◽  
Hematopoietic Stem Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cell Transplant ◽  
Minor Response ◽  
Hematopoietic Stem ◽  
The Impact

Abstract Abstract 4119 Background: The outcome of multiple myeloma (MM) has improved significantly over the last 2 decades due to the availability of several novel agents and an increasing use of high-dose chemotherapy and autologous hematopoietic stem cell transplant (auto-HCT). There is considerable evidence that the response to induction therapy predicts a favorable outcome after high-dose chemotherapy and auto-HCT. In this report, we evaluated the impact of pre-transplant response to conventional agents on post auto-HCT outcomes including time to progression (TTP), progression free survival (PFS) and overall survival (OS). Methods: 1567 patients received auto-HCT at UT-MD Anderson Cancer Center between 1988 and December 2010. Pre auto-HCT disease status was divided into the following prior auto-HCT response groups: complete response (CR), very good partial response (VGPR), partial response (PR), minor response (MR), stable disease (SD) and progressive Disease (PD). The primary objective was to study the impact of prior response on the outcome. Demographics, disease-related and transplant-related variables were collected. The distributions of TTP, PFS and OS were estimated by the Kaplan-Meier method. Log-rank test was performed to test the difference in survival between groups. Regression analyses of survival data was based on the univariate and multivariate Cox proportional hazards model. Results: Median age at auto-HCT was 56.8 years. Median time from diagnosis to auto-HCT was 7.9 months. Of the 1567 patients, 72 (4.6%) achieved CR before auto-HCT, 255 (16%) had VGPR, 848 (54%) had PR, 78 (5%) had MR, 189 (12%) had SD, 88 (5.6%) had PD, while the response was unknown in 37 (2%) patients. Almost 17% patients were 65 years or older at auto-HCT and approximately 7% had high-risk cytogenetic abnormalities. On univariate analysis, the response prior to auto-HCT had significant impact on TTP (p=<0.0001), PFS (p=<0.0001), and OS (p=<0.0001), In multivariate models, the response prior to auto-HCT still emerged as a significant predictor of TTP, PFS and OS (p =0.0055, p=0.0004 and p<0.0001, respectively) after adjusting for percent of plasma cells, time interval from diagnosis to transplantation and/ or creatinine level. In particular, patients who achieved CR prior to auto-HCT had significantly longer TTP, PFS and OS when compared to patients who had PR, MR, SD or PD (Figures 1–Fig 3). In contrast, TTP, PFS and OS were not significantly different between patients who achieved a CR or VGPR prior to auto-HCT. Conclusion: Patient who achieved CR or VGPR before undergoing an auto-HCT had significantly longer TTP, PFS and OS after the transplant. These results highlight the importance of effective anti-myeloma therapy to maximize the response before proceeding to auto-HCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals High-dose chemotherapy following autologous hematopoietic stem cell transplantation for multiple myeloma in the real world setting. Single-center experience

2020 ◽  
Vol 22 (2) ◽  
pp. 126-132
Author(s):  
Nikita E. Mochkin ◽  
Vladislav O. Sarzhevskiy ◽  
Julia N. Dubinina ◽  
Elena G. Smirnova ◽  
Denis A. Fedorenko ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Partial Response ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem

Aim. To assess the long-term results of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) for multiple myeloma (MM) in the real setting and influence of different factors on the results. Materials and methods. From 2006 till 2018 in Pirogovs Center were performed 205 autoHSCT for patients with MM, aged between 3172 years (median 55). 55 (26.8%) autoHSCT were tandem. The study population consisted of 45% men and 55% women. Median follow up was 75 months. For the majority of patients autoHSCT was performed after achieving at least partial response according to the IMWG criteria. For less than 9% patients, autoHSCT was done for chemo refractory disease as a salvage therapy. Most of the patients 179 (87.4%) were treated using melphalan-based conditioning regimens (140 or 200 mg/m2). Initial staging according to ISS was done for less than 30% and to R-ISS less than 5% patients. No transplant-related mortality till D + 100 was registered. 186 patients were included in the final analysis. Results. The 5-year OS and PFS were 73% and 34%, respectively, that corresponds with international data. For patients, younger than 60, 5-year OS was 82%; for patients older than 60, it was 49% (p0.05). For tandem autoHSCT, 5-year PFS was 44%; for single autoHSCT 26% (p0.05). 5-year PFS after autoHSCT was significantly higher in patients with complete and stringent complete response after autoHSCT (44%) in comparison with the group with partial and very good partial response (77%). Sex, response before and after autoHSCT, immunomodulatory drugs in induction, number of prior lines of induction therapy, conditioning regimen and maintenance therapy had no influence on OS. PFS had the same tendencies, except tumor response after autoHSCT. Conclusion. In a real setting, we recommend tandem autoHSCT for all eligible patients with chemosensitive disease, despite the depth of response and induction therapy. Patients younger than 60 and patients with complete of greater response after autoHSCT, benefit from the autoHSCT most. Implementation of total cytogenetic testing according to the R-ISS is of a great value for further development of autoHSCT for MM in Russia.

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.

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.

Combined Use of Multi-Day Doses of Palonosetron and Aprepitant with Low Dose Dexamethasone In Prevention of Nausea and Emesis Among Patients with Multiple Myeloma and Lymphoma Undergoing Autologous Hematopoietic Stem Cell Transplant (ASCT): A Pilot Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1335-1335
Author(s):  
Delva Deauna-Limayo ◽  
Omar Aljitawi ◽  
Siddhartha Ganguly ◽  
Sunil Abhyankar ◽  
Jo Wick ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Research Funding ◽  
Low Dose ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Combined Use ◽  
Delayed Cinv

Abstract Abstract 1335 High dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) is a standard of care therapy patients with multiple myeloma and relapsed/refractory lymphomas. Unfortunately, high dose chemotherapy used in the preparative regimen is considered highly emetogenic. In one study, only 20% of patients undergoing ASCT managed to remain emesis-free. The 5-HT3 receptor antagonist is considered the backbone of anti-emetic regimens in this setting. Despite the combined use of these agents with dexamethasone, only 47% of recipients would achieve emetic control. Palonosetron, a second generation 5-HT3 antagonist, is approved as a single 0.25 mg IV dose in prevention of acute emesis in highly emetogenic chemotherapy regimens. Aprepitant represents a new class of oral anti-emetic which targets the NK-1 receptor. It is effective for both acute and delayed onset emesis. Objectives and Methods: Patients undergoing ASCT for multiple myeloma (MM) and relapsed lymphoma at the University of Kansas Medical Center were offered this study. The primary objective was to assess emetic responses to prophylactic multi-day doses of palonosetron, aprepitant and low dose dexamethasone. Emetic responses were assessed by daily patient diaries and the Multinational Association for Supportive Care in Cancer Antiemetic Tool (MAT). Nausea was measured using a Nausea Visual Score (NVS) of 0 to 10 with score of 0 having no nausea. A “modified” Osoba module was used to assess quality of life (QOL); and non-hematologic toxicities were evaluated. Preparative regimens were MEL140-200 for MM and BEAM or BEAC +/− rituximab for lymphomas. Standard doses aprepitant 125/80/80 mg were administered on days - 3, - 2, - 1 for MM group, and days - 7, - 6, - 5 for lymphoma group. Low dose dexamethasone 4 mg IV and multi-day doses of palonosetron 0.25 mg IV were administered on days - 3, - 2, -1, and on days - 7 thru - 3 for the MM and lymphoma groups, respectively. In both groups, palonosetron was repeated on day + 3. Acute chemotherapy-induced nausea/vomiting (CINV) was defined as nausea and/or vomiting within 24 hours of chemotherapy. Delayed CINV was defined as nausea and/or vomiting after 24 and up to 72 hours after chemotherapy; and extended CINV as nausea and/or vomiting after 72 hours of chemotherapy. Emetic responses were defined as follows: Complete Control (CC) – no emetic episode in 24 hours, no rescue medications and NVS of ≤ 2.5; Complete Emetic Response (CR) – 0 emetic episode, no rescue; Major Emetic Response (MR) – 1–2 episodes; Minor Emetic Response (MR) – 3–5 episodes; Failure - >5 episodes. Results: Between October 2007 and January 2010, 20 patients were enrolled, of which 18 were considered evaluable, 9 MM and 9 lymphoma – both Hodgkin's and non-Hodgkin's lymphoma. There were 11 males and 9 females. Median age was 55 (range: 35–66). All patients achieved at least a major emetic response in the acute, delayed and extended phases. Acute CINV responses were achieved in all patients: CC 2/9 (22%) and MR 7/9 (78%) in MM patients and CC 2/9 (22%), CR 2 (22%) and MR 5/9 (56%) in lymphoma patients. Delayed CINV responses were achieved in all patients: CC 2/9 (22%), CR 1 (11%) and MR 6/9 (67%) in MM patients and CC 4/9 (44%), CR 1 (11%) and MR 4/9 (44%) in lymphoma patients. Finally, all patients achieved extended CINV responses: CC 1/9 (11%) and MR 8/9 (89%) in MM patients and CC 2/9 (22%) and MR 7/9 (78%) in lymphoma patients. Eight patients developed grade 2–3 non-hematologic toxicities (arrhythmia, infection, febrile neutropenia, gastric mucositis, abdominal pain, and hyponatremia) attributed to the preparative transplant regimen. Only the arrhythmia was felt to be possibly related to the study drugs. Data on QOL will be presented during the conference. Conclusion: The combination of multi-day palonosetron combined with aprepitant and low dose dexamethasone appear to be well tolerated and effective in achieving at least a major emetic response in 100% of patients with MM and lymphoma undergoing high-dose therapy and ASCT. These encouraging results should warrant further evaluation in a larger population of ASCT patients. Disclosures: Deauna-Limayo: Eiasi: Research Funding. Aljitawi:Eisai: Research Funding.

scholarly journals Treatment of Acquired von Willebrand Syndrome and Prevention of Bleeding Postautologous Stem Cell Transplant during Severe Pancytopenia with IVIG

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Behyar Zoghi ◽  
Paul Shaughnessy ◽  
Roger M. Lyons ◽  
Richard Helmer ◽  
Carlos Bachier ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Significant Risk ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Acquired Von Willebrand Syndrome ◽  
Von Willebrand

The use of high dose chemotherapy followed by autologous hematopoietic stem cell transplantation for remission consolidation after initial induction represents standard of care for patients with multiple myeloma. Patients with myeloma and Acquired von Willebrand Syndrome (AVWS) undergoing autologous stem cell transplant (ASCT) are at significant risk of bleeding due to the profound thrombocytopenia, low Factor VIII levels, fever, and toxicities associated with the preparative regimen. We report a patient with AVWS associated with multiple myeloma who underwent autologous stem cell transplants as consolidation after initial induction and again at relapse. He was successfully treated with high dose intravenous immunoglobulin (IVIG) prior to each transplant with rapid resolution of AVWS.

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