Introduction
Dialysis‐dependent (DD) multiple myeloma patients (MM) have a poor prognosis and high tumour burden, thus may benefit from autologous peripheral blood stem cell transplantation ...(auto‐PBSCT), however, these patients have an increased risk of toxicity.
Aims
To evaluate the outcomes (toxicity, PFS, OS) of high dose therapy followed by auto‐PBSCT during an observational study and after propensity score matching.
Patients and methods
Between 2004‐2015, 24 DD patients, (aged 38‐67 years), ISS 3, treated with auto‐PBSCT, requiring dialysis at diagnosis and auto‐PBSCT were evaluated, matched and compared to 55 normal renal function MM patients (NRF) with ISS 3 for outcomes of interest.
Results
In DD patients compared to NRF patients risk of mucositis (88% vs 55%), infection (79% vs 51%), parenteral nutrition (50% vs 24%), diarrhoea (71% vs 38%), prolonged duration of hospitalisation (medians: 30 vs 21 days), requirement for RBC transfusion (83% vs 36%) were significantly higher, while no significant differences were found in post‐transplant response (ORR; 75% vs 87%), 5‐year PFS (36% vs 20%) and OS (39% vs 50%). Subgroup analyses based on toxicity supported these results.
Conclusions
Despite the increased risk of toxicity in DD patients these events do not significantly affect both the PFS and OS.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
High‐dose chemotherapy with autologous hematopoietic stem cell transplantation (auto‐HSCT) improves the outcome of patients with multiple myeloma (MM). It seems that auto‐HSCT is also a ...feasible therapeutic option in MM dialysis‐dependent (MMDD) patients. However, to perform transplantation, a sufficient number of stem cells must be collected.
Materials and Methods
Given that data on mobilization of auto‐HSC efficacy and safety in dialysis‐dependent patients are limited, we report data from all Polish Centers belonging to the Polish Myeloma Study Group. Twenty‐eight dialysis‐dependent MM‐patients were enrolled into this retrospective analysis. The study population comprised patients diagnosed between 2004 and 2015 in whom an attempt to collect auto‐HSC was made (68%: women, median age: 56). Patients received granulocyte‐colony stimulating factor (G‐CSF) alone or in combination with chemotherapy and autologous peripheral blood stem cells (auto‐PBSCs) were collected by leukapheresis.
Results and Conclusions
The success rate in terms of obtaining sufficient number of CD34(+) cells/kg for an auto‐HSCT (≥2 × 106 cells/kg body weight) during the first mobilization attempt was 92% (26/28 patients), and for 2 auto‐HSCTs (≥4 × 106 cells/kg) – was 75% (21/28 patients). After the second mobilization attempt (undertaken in 8 patients), a sufficient number of CD34(+)/kg cells for an auto‐HSCT was obtained for all patients and the number of CD34(+)/kg collected cells was sufficient for 2 auto‐HSCT in 6 additional patients. Hematologic toxicity and infections were the most frequent complications. Higher doses of cytarabine (>1.6 g/m2) and cyclophosphamide (> 2 g/m2) should be avoided in MMDD patients due to toxicity. Further studies are needed to establish mobilization regimens, confirm their safety, and dosing in MMDD patients.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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