Associate professor Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
Introduction: Autologous stem cell transplantation (ASCT) remains the standard of care for patients with newly diagnosed multiple myeloma (MM) despite the approval of novel agents. Numerous trials have demonstrated a progression-free survival (PFS) advantage with ASCT. To study the demographics, clinical profile, and outcomes of patients with MM undergoing ASCT at a tertiary care center in northern India.
Methods: This is a medical records review of 29 patients with MM who underwent ASCT between 2007 and 2021. The demographics, clinical profile, induction regimen, details of ASCT, and outcomes were retrieved. Descriptive analysis, Progression Free Survival (PFS), and Overall Survival (OS) were determined. Data are expressed as median and interquartile range (IQR).
Results: The median age of the cohort was 56 years (50-61) and 21 (72%) were males. The follow-up duration from diagnosis was 60 months (18-74). The most common immunoglobulin isotype was IgG kappa (28%) followed by IgG lambda (24%) and IgA kappa (21%). R-ISS staging was available for 26 patients and 21 of 26 (72%) had stage III disease. High-risk cytogenetics were identified in 19 patients (66%). Nine patients (47%) had t(4;14) and four (21%) had deletion 17p. Triplet induction consisting of Bortezomib, dexamethasone, and IMiD was the most common induction regimen (18, 62%). Two patients received quadruplet induction consisting of daratumumab, bortezomib, lenalidomide, and dexamethasone. The median time from diagnosis to transplant was 12 months (8-22). Most patients (24, 79%) were transplanted in first complete remission (CR1). The most common conditioning regimen was high dose melphalan, dosed at 200mg/m2. Nine patients (31%) received a reduced dose of melphalan (140mg/m2) in view of reduced GFR, poor ECOG performance status, secondary amyloidosis, and other co-morbidities. The median stem cell dose was 5.44 x106/kg (4.98-6.01 x 106/kg). The median time to engraftment was 9 days (8-10). Mucositis was the most common complication post ASCT (26, 90%), and grade 3/4 mucositis complicated seven transplants (24%). Three patients (10.3%) died during the post-ASCT neutropenic period secondary to sepsis. Eleven patients (42%) relapsed, and the median duration of remission (PFS) post-ASCT was 34 months (30.5-40.5) (Figure 1). Of those who relapsed, five (45.5%) died of disease progression, one died (9%) of myocardial infarction and five patients (45.5%) were alive at the time of the last follow-up. The OS was 89.7% with the median survival time post-ASCT being 39 months (7-60).
Conclusions: ASCT remains the standard of care for patients with multiple myeloma, especially in lower-middle income countries where access to second-line therapies is limited..
