10-year experience in the treatment of multiple myeloma with autologous stem cell transplantation

Abstract

Background: Multiple myeloma (MM) is a plasma-cell proliferative neoplasm.The second most common hematologic cancer, with 5 years prevalence about 183 000. Incidence is 5,7 /100 000 in EU. 5-years survival is 28%. Treatment with HDT and single autologous transplantation is a category I recommendation of the NCCN. In young patients, the impact of dose intensity has been demonstrated, and single HDT supported with ASCT using a conditioning regimen with Melphalan should be considered a standard of care. Double transplantation can be proposed to patients failing to achieve a VGPR after a fi rst ASCT. Material and methods: during a 10 years period we have performed 195 stem-cell transplantation in different hematological malignancies. 34 (17,5%) high dose chemotherapy and autologous stem-cells transplantation were performed in 30 patients (4 tandem transplantation) with multiple myeloma. In this trial we retrospectively analyzed the epidemiology characteristic of this patients. Gender: Female: 16 Male: 14. Median age: 51 years (from 43- 64 years). Results: Diagnose was made according to Salmon and Durie criteria. 25 patients with IgG, 4 with IgA, and 1 with light chain myeloma. Bence-Jones positive myeloma was diagnosed in 8 patient, 5 of them were with chronic renal failure. Fracture of spine was presented in 12 patients and 2 patients has fracture of hip. For the induction of remission we used VAD regimen in 20 patients, Cy-Tal-Dex in 10 patients. As a second line therapy in the case of failure to achieve complet remission we introduce Thal/Dex regimen. in 10 patient Only in two patient we use Bortezomib, Alkeran, Dexamethason. Conditioning regimen consisted Melphalan 200 mg/m2. In tandem transplantation the dose of second conditioning was 140 mg/m2.The volume of CD34+ cells was 3,88 x 108/Kg.bw. Period from diagnose to transplantation is 12 months. From 30 patients 80% are alive, 6 died (3 renal failure, 2 fatal cerebral bleeding and 1 multiorgan failure). The DFS is 24 months, OS is 48 months and survival after transplantation is 35 months. Conclusion: novel agents such as thalidomide, bortezomib, or lenalidomide have been introduced to improve high-dose therapy, and promising results have been reported. Conversely, results from myeloablative allogeneic stem cell transplantation remain disappointing due to high TRM, justifying the exploration of strategies such as RIC, which have been shown to be feasible but for which proof of effi cacy requires continued study.