High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome
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 transplantati...
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Wolters Kluwer Medknow Publications
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doaj-a457d1fdc94b42dbb2dff4b3973b30af2020-11-25T02:41:58ZengWolters Kluwer Medknow PublicationsIndian Journal of Medical Research0971-59162019-01-01149673073910.4103/ijmr.IJMR_1593_18High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcomeLalit KumarDev RamavathBabita KatariaAkash TiwariAbhishek RajSantosh Kumar ChellapuramAnjali MookerjeeRanjit Kumar SahooPrabhat S MalikAtul SharmaRitu GuptaOm dutt SharmaAhitagni BiswasRakesh KumarSanjay Thulkarfor AIIMS Myeloma GroupBackground & 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.http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2019;volume=149;issue=6;spage=730;epage=739;aulast=KumarAutologous stem cell transplantation - long-term outcome - multiple myeloma - predictors - prognostic factors - response to transplant |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lalit Kumar Dev Ramavath Babita Kataria Akash Tiwari Abhishek Raj Santosh Kumar Chellapuram Anjali Mookerjee Ranjit Kumar Sahoo Prabhat S Malik Atul Sharma Ritu Gupta Om dutt Sharma Ahitagni Biswas Rakesh Kumar Sanjay Thulkar for AIIMS Myeloma Group |
spellingShingle |
Lalit Kumar Dev Ramavath Babita Kataria Akash Tiwari Abhishek Raj Santosh Kumar Chellapuram Anjali Mookerjee Ranjit Kumar Sahoo Prabhat S Malik Atul Sharma Ritu Gupta Om dutt Sharma Ahitagni Biswas Rakesh Kumar Sanjay Thulkar for AIIMS Myeloma Group High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome Indian Journal of Medical Research Autologous stem cell transplantation - long-term outcome - multiple myeloma - predictors - prognostic factors - response to transplant |
author_facet |
Lalit Kumar Dev Ramavath Babita Kataria Akash Tiwari Abhishek Raj Santosh Kumar Chellapuram Anjali Mookerjee Ranjit Kumar Sahoo Prabhat S Malik Atul Sharma Ritu Gupta Om dutt Sharma Ahitagni Biswas Rakesh Kumar Sanjay Thulkar for AIIMS Myeloma Group |
author_sort |
Lalit Kumar |
title |
High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome |
title_short |
High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome |
title_full |
High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome |
title_fullStr |
High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome |
title_full_unstemmed |
High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome |
title_sort |
high-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: predictors of long-term outcome |
publisher |
Wolters Kluwer Medknow Publications |
series |
Indian Journal of Medical Research |
issn |
0971-5916 |
publishDate |
2019-01-01 |
description |
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. |
topic |
Autologous stem cell transplantation - long-term outcome - multiple myeloma - predictors - prognostic factors - response to transplant |
url |
http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2019;volume=149;issue=6;spage=730;epage=739;aulast=Kumar |
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