Treatment of multiple myeloma at Clinical Department of Hematology, University Medical Centre Ljubljana with autologous hematopoietic stem cell transplantation in years 2014 and 2015
Abstract
Introduction. In the period from 01.01.2014 to 31.12.2015 at Clinical Department of Hematology, University Medical Centre Ljubljana, we treated 73 multiple myeloma patients with first autologous hematopoietic stem cell transplantation (HSCT).
Methods and results. Age of patients ranged from 27 to 72 years with the median age of 60 years. Induction treatment at the time of diagnosis consisted of: VD (bortezomib, dexamethasone) 60/73 patients (82%), VCD (bortezomib, cyclophosphamide, dexamethasone) 10/73 patients (14%) and VTD (bortezomib, thalidomide, dexamethasone) 3/73 (5%) patients. As part of induction therapy, patients received from 1 to 9 cycles of treatment. Response to induction therapy prior to HSC(hematopoietic stem cells) collection was as follows: CR(complete remission )7/73(10%), VGPR (very good partial response) 28/73(38%), PR (partial response) 23/ 73(32%), SD (stable disease) 11/73(15%) andPD (progressive disease) 4/73(5%) patients. Response to induction therapy immediately prior to autologous HSCT: CR9/73 (12%), VGPR32/73 (44%), PR17/73(23%), SD 8/73(11%) and PD6/73(8%) patients. Response to induction therapy and the first autologous HSCT at D+100 after HSCT: CR9/67 (13%), VGPR 34/67 (51%), PR 12/67 (18%), SD 3/67 (4 %) and PD 7/67 (10%) patients (in 6 patients data are missing, because they are not mature yet). With single HSCT 63 patients were treated, while 10 patients received double or second HSCT. The overall mortality of patients treated during the period from 01.01.2014 to 31.12. 2015 was 6/73 or 8.2%.
Conclusions. The treatment of multiple myeloma with autologous HSCT remains the cornerstone of efficiency,as demonstrated by the increasing share of the most desired responses to treatment, ie. CR and VGPR. The treatment mortality rate was within expectation limits.
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References
Zver S, Skopec B, Podgornik H, Reberšek K, Mlakar U. Incidenca in zdravljenje diseminiranega plazmocitoma na Kliničnem oddelku za hematologijo UKC Ljubljana v obdobju 2008–2011. Zdrav Vestn. 2012; 81 Supl 2: II-65–79.
Skopec B, Pretnar U, Mlakar U, Zver S. Alogenična presaditev krvotvornih matičnih celic pri bolnikih z diseminiranim plazmocitomom na kliničnem oddelku za hematologijo UKC Ljubljana. Zdrav Vestn. 2012; 81 Supl 2: II-80–86.
Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, et al. Monoclonal gammopathy of undetermined signifcance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia. 2010; 24 (6): 1121–7.
Kyle RA, Terneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, et al. Prevalence of monoclonal gammopathy of undetermined signifcance. N Engl J Med. 2006; 354 (13): 1362–9.
Gertz MA, Dingli D. How we manage autologous stem cell transplantation for patients with multiple myeloma. Blood. 2014; 124 (6): 822–90.
Mlakar U, Andoljšek D, Fikfak N, Glaser M, Grat M, Grmek-Zemljič T, et al. Smernice za odkrivanje in zdravljenje diseminiranega plazmocitoma. Zdrav Vestn. 2006; 75 (1): 3–8.
Zver S, Mlakar U. Slovenske smernice za obravnavo diseminiranega plazmocitoma 2015. Zdrav Vestn. 2015; 84 (5): 335–51.
Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014; 15 (12):e538-e48.
Ludwig H, Sonneveld P, Davies F, Blade J, Boccadoro M, Cavo M, et al. European Perspective on Multiple Myeloma Treatment Strategies in 2014. Oncologist. 2014; 19 (8): 829–44.
Stewart AK, Rajkumar SV, Dimopoulos MA. Carflzomib, Lenalidomide, and Dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015; 372 (2): 142–52.
San Miguel J, Weisel K, Morreau P. Pomalidomide plus low dose dexamethasone versus high dose dexamethasone alone for patients with relapsed or refractory multiple myeloma: a randomised open label phase III trial. Lancet Oncol. 2013; 14 (11): 1055–66.
Moreau P, Masszi T, Grzasko N, Bahlis NJ, Hansson M, Pour N. Oral Ixazomib, Lenalidomide and Dexamethasone for multiple myeloma. N Engl J Med. 2016; 374 (17): 1621–34.
Attal M, Harosseau JL, Facon T. IGFM single versus double autologous stem cell transplantation for multiple myeloma. N Engl J Med. 2003; 349 (269): 2495–2502.
Jimenez-Zapeda VH, Mikhael J, Winter A. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression free survival and overall survival. Biol Blood Marrow Transplantation. 2012; 18 (5): 773–79.
Engelhardt M, Terpos E, Kleber M, Gay F, Wasch R, Morgan G, et al. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma. Haematologica. 2014; 99 (2): 232–42.
Chang WJ, Dispenzieri A, Chim CS, Fonseca R, Goldschmidt H, Lentzsch S, et al. IMWG consensus on risk stratifcation in multiple myeloma. Leukemia. 2014; 28 (2): 269–77.
Palumbo A, Anderson K. Medical progress: Multiple myeloma. N Engl J Med. 2011; 364 (11): 1046–60.
Ross FM, Avet-Loiseau H, Ameye G, Gutierrez NC, Liebisch P, O‘Connor S, et al. Report from the European Myeloma Network on interphase FISH in multiple myeloma and related disorders. Haematologica. 2012; 97 (8): 1272–7.
Leiba M, Kedmi M, Duek A, Friedman T, Weiss M, Leiba R. Bortezomib-Cyclophosphamide. Dexametasone versus Bortezomib-Talidomide Dexametasone based regimens as induction therapies in newly diagnosed transplant eligible patients with MM: a meta analysis. British J Haematol. 2014; 166 (5): 702–710.
Moreau P, Hulin C, Macro M, Caillot D, Chaleteix C, Roussel M. VTD is superior to VCDprior to intensive therapy in multiple myeloma: results of the prospective IFM2013–04 trial. Blood. 2016; 127 (21): 2569–76.
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