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.
High-dose therapy/autologous stem cell transplantation in patients with chemosensitive multiple myeloma: predictors of complete remission