clinical heamatology
Contributions
Type: Publication Only
Background
Multiple myeloma prognosis may correlate with the patient's clinical characteristics as well as biologic variables of the malignant clone.
In the mid 90's with the systematic use of high dose melphalan and ASCT the average survival rate was 3-4years,while after 2007 with the indroduction of immunomodulatory agents and proteasome inhibitors, life expectancy exceeded the limit of 7-8 years.At the same time the impact of the molecular features of the malignant cell in prognosis was strongly validated and acknowledged.
Aims
In this cohort we present patients diagnosed with multiple myeloma before 2006, who remain alive at least eight years after the initial diagnosis.The purpose of the study was to identify common clinical characteristics of favorable prognosis among long term survivors independently of cytogenetic or molecular abberations.
Methods
The present study included 26 patients(19males,7 females) diagnosed with multiple myeloma between 2000-2005 in our institution.The median age at the time of diagnosis was 57( 44-75 )yrs.Αmong the cases reported 10 were IgGk, 4 IgGλ,3IgAk, 3IgAλ,3 light chain(λ), 2 non secretory and one had tripple M-component(IgGk/IgAk/IgDk).
The majority of patients (25/26) were eligible of treatment initiation according to the current criteria (presenting with CRAB) .23 patiens were diagnosed with bone disease,14 had anemia,11 presented with renal insufficiency and 3 with hypercalcemia.In 6/26 patients MGUS preceeded the diagnosis for more than 12 months.
At staging by Salmon Durie 15/26 were at stage III,6 at stage II,5 at stage I,while according to ISS 6/26 were at stage III.Classical cytogenetic analysis was performed in bone marrow speciments for 20/26 patients and all had a normal karyotype .
23/26 received VAD or VAD-Caelyx regiments.Two received melphalan -steroids combination and one bortezomib-steroids.Palliative radiotherapy was applied to all patients having bone disease (23/26).19/26 received high dose melphalan and autologous transplant while 5 of them were submitted to a second transplantation (tandem) and 15 reached complete remission after transplantation.22/26 followed a maintenance schedule with thalidomide.
Results
15 out of 26 patients remain in complete remission 9-15 years after diagnosis,while 3 are alive with relapsed or progressive disease.8 patients died >8-14 years after diagnosis(7 died from disease complications and one from an irrelevant cause).Although no statistical analysis can be performed in this sample,two different subgroups are revealed:the first subgroup consists of 15 patients of younger age (median 54),no comorbidities,with bone disease as the main clinical feature,who were treated with high dose melphalan and ASCT and achieved CR according to the contemporary response criteria.The latter subgroup included 9 patients of older age with previous MGUS diagnosis (mostly IgGk),whose survival exceeded the average life expectancy.
Summary
A clinical profile of younger age,lower ISS, prolonged PFS is compatible with long term survival . ISS appears to have higher prognostic value than Salmon Durie .Even in the era of novel treatment agents clinical characteristics of the patient may indicate survival benefits although the use of cytogenetic or molecular analysis when available has become mandatory.
Keyword(s): Myeloma
Session topic: Publication Only
Type: Publication Only
Background
Multiple myeloma prognosis may correlate with the patient's clinical characteristics as well as biologic variables of the malignant clone.
In the mid 90's with the systematic use of high dose melphalan and ASCT the average survival rate was 3-4years,while after 2007 with the indroduction of immunomodulatory agents and proteasome inhibitors, life expectancy exceeded the limit of 7-8 years.At the same time the impact of the molecular features of the malignant cell in prognosis was strongly validated and acknowledged.
Aims
In this cohort we present patients diagnosed with multiple myeloma before 2006, who remain alive at least eight years after the initial diagnosis.The purpose of the study was to identify common clinical characteristics of favorable prognosis among long term survivors independently of cytogenetic or molecular abberations.
Methods
The present study included 26 patients(19males,7 females) diagnosed with multiple myeloma between 2000-2005 in our institution.The median age at the time of diagnosis was 57( 44-75 )yrs.Αmong the cases reported 10 were IgGk, 4 IgGλ,3IgAk, 3IgAλ,3 light chain(λ), 2 non secretory and one had tripple M-component(IgGk/IgAk/IgDk).
The majority of patients (25/26) were eligible of treatment initiation according to the current criteria (presenting with CRAB) .23 patiens were diagnosed with bone disease,14 had anemia,11 presented with renal insufficiency and 3 with hypercalcemia.In 6/26 patients MGUS preceeded the diagnosis for more than 12 months.
At staging by Salmon Durie 15/26 were at stage III,6 at stage II,5 at stage I,while according to ISS 6/26 were at stage III.Classical cytogenetic analysis was performed in bone marrow speciments for 20/26 patients and all had a normal karyotype .
23/26 received VAD or VAD-Caelyx regiments.Two received melphalan -steroids combination and one bortezomib-steroids.Palliative radiotherapy was applied to all patients having bone disease (23/26).19/26 received high dose melphalan and autologous transplant while 5 of them were submitted to a second transplantation (tandem) and 15 reached complete remission after transplantation.22/26 followed a maintenance schedule with thalidomide.
Results
15 out of 26 patients remain in complete remission 9-15 years after diagnosis,while 3 are alive with relapsed or progressive disease.8 patients died >8-14 years after diagnosis(7 died from disease complications and one from an irrelevant cause).Although no statistical analysis can be performed in this sample,two different subgroups are revealed:the first subgroup consists of 15 patients of younger age (median 54),no comorbidities,with bone disease as the main clinical feature,who were treated with high dose melphalan and ASCT and achieved CR according to the contemporary response criteria.The latter subgroup included 9 patients of older age with previous MGUS diagnosis (mostly IgGk),whose survival exceeded the average life expectancy.
Summary
A clinical profile of younger age,lower ISS, prolonged PFS is compatible with long term survival . ISS appears to have higher prognostic value than Salmon Durie .Even in the era of novel treatment agents clinical characteristics of the patient may indicate survival benefits although the use of cytogenetic or molecular analysis when available has become mandatory.
Keyword(s): Myeloma
Session topic: Publication Only