Regulatory T cells affect early relapse following high-dose chemotherapy with autologous hematopoietic stem cell transplantation in multiple myeloma patients

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.

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

Blood ◽

10.1182/blood.v118.21.333.333 ◽

2011 ◽

Vol 118 (21) ◽

pp. 333-333 ◽

Cited By ~ 1

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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Impact of Hepatitis B Core Antibody (HBcAb) Seropositivity on the Outcome of High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2013.12.043 ◽

2014 ◽

Vol 20 (2) ◽

pp. S46-S47

Author(s):

Laura Biritxinaga ◽

Sarah Francesca Jauch ◽

Uday R. Popat ◽

Mehnaz A. Shafi ◽

Nina Shah ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Hepatitis B ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

High Dose Chemotherapy ◽

High Dose ◽

Hematopoietic Stem

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Outcomes Among High-Risk and Standard-Risk Multiple Myeloma Patients Treated With High-Dose Chemotherapy and Autologous Hematopoietic Stem-Cell Transplantation

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2015.07.641 ◽

2015 ◽

Vol 15 (11) ◽

pp. 687-693 ◽

Cited By ~ 16

Author(s):

Syed M. Kazmi ◽

Maliha Nusrat ◽

Hilal Gunaydin ◽

Amanda M. Cornelison ◽

Nina Shah ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

High Risk ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

High Dose Chemotherapy ◽

High Dose ◽

Hematopoietic Stem ◽

Standard Risk

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

Modern Oncology ◽

10.26442/18151434.2020.2.200179 ◽

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.

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