Contributions
Abstract: PB1996
Type: Publication Only
Background
Despite the era of emerging novel agents, autologous peripheral blood stem cell transplantation remains backbone of myeloma treatment.
Aims
The main aim of our study was to evaluate the role of tandem transplantation in myeloma treatment as well as prognostic indices in era of novel drugs.
Methods
We consecutively included all patients transplanted due to myeloma at our center from 2012 to the end of 2016. Patients were treated with either VAD or bortezomib based therapy. After induction treatment, all patients proceeded to mobilization therapy cyclophosphamide 3g/m2 and received pegfilgrastim. Preparative regimen was either MEL 200 for fit patients or MEL 140 for frail and those with severe renal function impairment. Patients treated with VAD who had poor response after autologous transplantation were subsequently treated with bortezomib based therapy. We examined following baseline characteristics: age, proportion of plasma cells in bone marrow biopsy or aspirate, FISH and lactate dehydrogenase (LDH). Additionally, for each patient International Staging System (ISS), Revised International Staging System (ISS-R) and Durie Salmon staging were calculated. Patients with other malignant diseases prior to myeloma diagnosis were excluded. The main outcomes were overall survival (OS) defined as death from myeloma or any other cause and time to next treatment (TNT), defined as time from transplant to next new therapy or death of any cause.
Results
From January 2012 to December 2016 hundred and one patient with MM (49 male, 52 female), median age 55 (range 22-71), were transplanted. Bortezomib based induction therapy was used in 55 (54,5%) and VAD induction was used in 46 (45.5%) patients. Median OS of all treated patients was 73 months; median OS of VAD group was 73 months while in bortezomib group median OS was not reached, but this difference was not statistically significant (p=0,13). TNT was significantly longer in bortezomib group than in VAD one (27,8 vs 17,5 months respectively; p=0,02). Interestingly prognostic indices could not discriminate patient groups according to OS (p=0,1), but could discriminate them due to TNT (p=0,008), possibly due to cross-over to bortezomib treatment after treatment failure. TNT had a significant correlation with levels of LDH (p=0,04) and no significant correlation with number of plasma cells in bone marrow. OS was significantly longer in those with longer duration of time to next treatment (p=0,0004). There was no difference in OS or TNT in patients treated with tandem transplant vs single transplant (p=0,68 and p=0,57 respectively), possibly due to heterogeneity of tandem group.
Conclusion
Even though novel drug therapy seems to converge risk groups to lower ones, prognostic indices remain relevant. Due to heterogeneity of patients and myriad of known prognostic factors further studies are needed so they may be translated into risk adapted therapy approach.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): prognosis, Myeloma, Autologous hematopoietic stem cell transplantation
Abstract: PB1996
Type: Publication Only
Background
Despite the era of emerging novel agents, autologous peripheral blood stem cell transplantation remains backbone of myeloma treatment.
Aims
The main aim of our study was to evaluate the role of tandem transplantation in myeloma treatment as well as prognostic indices in era of novel drugs.
Methods
We consecutively included all patients transplanted due to myeloma at our center from 2012 to the end of 2016. Patients were treated with either VAD or bortezomib based therapy. After induction treatment, all patients proceeded to mobilization therapy cyclophosphamide 3g/m2 and received pegfilgrastim. Preparative regimen was either MEL 200 for fit patients or MEL 140 for frail and those with severe renal function impairment. Patients treated with VAD who had poor response after autologous transplantation were subsequently treated with bortezomib based therapy. We examined following baseline characteristics: age, proportion of plasma cells in bone marrow biopsy or aspirate, FISH and lactate dehydrogenase (LDH). Additionally, for each patient International Staging System (ISS), Revised International Staging System (ISS-R) and Durie Salmon staging were calculated. Patients with other malignant diseases prior to myeloma diagnosis were excluded. The main outcomes were overall survival (OS) defined as death from myeloma or any other cause and time to next treatment (TNT), defined as time from transplant to next new therapy or death of any cause.
Results
From January 2012 to December 2016 hundred and one patient with MM (49 male, 52 female), median age 55 (range 22-71), were transplanted. Bortezomib based induction therapy was used in 55 (54,5%) and VAD induction was used in 46 (45.5%) patients. Median OS of all treated patients was 73 months; median OS of VAD group was 73 months while in bortezomib group median OS was not reached, but this difference was not statistically significant (p=0,13). TNT was significantly longer in bortezomib group than in VAD one (27,8 vs 17,5 months respectively; p=0,02). Interestingly prognostic indices could not discriminate patient groups according to OS (p=0,1), but could discriminate them due to TNT (p=0,008), possibly due to cross-over to bortezomib treatment after treatment failure. TNT had a significant correlation with levels of LDH (p=0,04) and no significant correlation with number of plasma cells in bone marrow. OS was significantly longer in those with longer duration of time to next treatment (p=0,0004). There was no difference in OS or TNT in patients treated with tandem transplant vs single transplant (p=0,68 and p=0,57 respectively), possibly due to heterogeneity of tandem group.
Conclusion
Even though novel drug therapy seems to converge risk groups to lower ones, prognostic indices remain relevant. Due to heterogeneity of patients and myriad of known prognostic factors further studies are needed so they may be translated into risk adapted therapy approach.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): prognosis, Myeloma, Autologous hematopoietic stem cell transplantation