Contributions
Abstract: PB2251
Type: Publication Only
Background
Multiple myeloma is a clonal B-cell disorder which is characterized by proliferation and accumulation of plasma cells in the bone marrow. The disease accounts for 13% of all hematologic malignancies.
Aims
To determine clinical presentation and compare response to induction treatment of multiple myeloma (MM) in newly diagnosed patients registered with the National Institute of Blood Disease (NIBD), Karachi.
Methods
Prospective, observational study was done from January 2013 to June 17 at our hospital in newly diagnosed MM patients and treatment was followed in study patients. Remission was documented after 4 cycles of treatment according to the standard response criteria of International Myeloma working group (IMWG).
Results
Eighty seven MM patients were included in the study. There were 52 males and 35 females. The median age was 57.26 (ranged from 40-65 years). The male to female ratio was 1.4:1. The main presenting complains included backache in 57% (n=50), pain in the legs 46% (n=40) and generalized weakness 63% (n=55). Anemia with hemoglobin level <10 g/dl was found in 71% (n=62) patients. The mean hemoglobin value was 8.9±2.1g/dl. Renal impairment was present in 49.4% (n=43) patients while 29% (n=25) patients had hypercalcemia. Patients were staged according to International staging system; 49% of the patients (n=43) were in stage II, 30% (n=26) patients in stage I and 21% (n=18) in stage III disease. About 48% (n=42) patients received thalidomide/melphalan/dexa (TMD), out of which 43% (n=18) achieved complete remission (CR) after 4 cycles while 57% (n=24) had partial response (PR). Thirty patients (34%) received lenalidomide/melphalan/dexa (LMD) of which 77% (n=23) achieved CR while 23% (n=7) patients had PR. Fifteen patients received lenalidomide/bortezomib/dexa (LBD), out of which 93% achieved CR. Chi square was applied to observe the association in treatment response and it was found statistically significant that treatment B and C had higher percentage of CR compared to treatment A (p-value= >0.05). However no significant results were found when treatment B and C was compared (p-value=<0.05). Twenty eight partial responders of treatment A and B received LBD, out of which 90% achieved remission. Overall survival at 3 years was 59%. Management related toxicities included weakness, constipation, diarrhea, nausea, vomiting and peripheral neuropathy.
Conclusion
Treatment with lenalidomide/melphalan/dexa and bortezomib combination was superior to the thalidomide group. Moreover, bortezomib addition results in complete remission in non-responders at induction and was well tolerated.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, Remission, Survival
Abstract: PB2251
Type: Publication Only
Background
Multiple myeloma is a clonal B-cell disorder which is characterized by proliferation and accumulation of plasma cells in the bone marrow. The disease accounts for 13% of all hematologic malignancies.
Aims
To determine clinical presentation and compare response to induction treatment of multiple myeloma (MM) in newly diagnosed patients registered with the National Institute of Blood Disease (NIBD), Karachi.
Methods
Prospective, observational study was done from January 2013 to June 17 at our hospital in newly diagnosed MM patients and treatment was followed in study patients. Remission was documented after 4 cycles of treatment according to the standard response criteria of International Myeloma working group (IMWG).
Results
Eighty seven MM patients were included in the study. There were 52 males and 35 females. The median age was 57.26 (ranged from 40-65 years). The male to female ratio was 1.4:1. The main presenting complains included backache in 57% (n=50), pain in the legs 46% (n=40) and generalized weakness 63% (n=55). Anemia with hemoglobin level <10 g/dl was found in 71% (n=62) patients. The mean hemoglobin value was 8.9±2.1g/dl. Renal impairment was present in 49.4% (n=43) patients while 29% (n=25) patients had hypercalcemia. Patients were staged according to International staging system; 49% of the patients (n=43) were in stage II, 30% (n=26) patients in stage I and 21% (n=18) in stage III disease. About 48% (n=42) patients received thalidomide/melphalan/dexa (TMD), out of which 43% (n=18) achieved complete remission (CR) after 4 cycles while 57% (n=24) had partial response (PR). Thirty patients (34%) received lenalidomide/melphalan/dexa (LMD) of which 77% (n=23) achieved CR while 23% (n=7) patients had PR. Fifteen patients received lenalidomide/bortezomib/dexa (LBD), out of which 93% achieved CR. Chi square was applied to observe the association in treatment response and it was found statistically significant that treatment B and C had higher percentage of CR compared to treatment A (p-value= >0.05). However no significant results were found when treatment B and C was compared (p-value=<0.05). Twenty eight partial responders of treatment A and B received LBD, out of which 90% achieved remission. Overall survival at 3 years was 59%. Management related toxicities included weakness, constipation, diarrhea, nausea, vomiting and peripheral neuropathy.
Conclusion
Treatment with lenalidomide/melphalan/dexa and bortezomib combination was superior to the thalidomide group. Moreover, bortezomib addition results in complete remission in non-responders at induction and was well tolerated.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, Remission, Survival