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. 2019 Jun;149(6):730-739.
doi: 10.4103/ijmr.IJMR_1593_18.

High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome

Lalit Kumar  1 , Dev Ramavath  1 , Babita Kataria  1 , Akash Tiwari  1 , Abhishek Raj  1 , Santosh Kumar Chellapuram  1 , Anjali Mookerjee  1 , Ranjit Kumar Sahoo  1 , Prabhat S Malik  1 , Atul Sharma  1 , Ritu Gupta  2 , Om Dutt Sharma  2 , Ahitagni Biswas  3 , Rakesh Kumar  4 , Sanjay Thulkar  5 ; for AIIMS Myeloma Group
Affiliations

High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome

Lalit Kumar et al. Indian J Med Res. 2019 Jun.

Abstract

Background & objectives: Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed.

Methods: Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2.

Results: Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] -213 (61%)], very good partial response (VGPR) -62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (≥3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ≥3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome.

Interpretation & conclusions: Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.

Keywords: Autologous stem cell transplantation; long-term outcome; multiple myeloma; predictors; prognostic factors; response to transplant.

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Conflict of interest statement

None

Figures

Fig. 1
Fig. 1
Overall survival for patients from date of transplant.
Fig. 2
Fig. 2
Progression free survival for patients from date of transplant.
See this image and copyright information in PMC

Comment in

  • Progress in multiple myeloma.
    Munker R, Monohan G. Munker R, et al. Indian J Med Res. 2019 Jun;149(6):693-694. doi: 10.4103/ijmr.IJMR_770_19. Indian J Med Res. 2019. PMID: 31496521 Free PMC article. No abstract available.

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