Director, BMT and Academics Jaslok Hospital and Research Centre Mumbai, Maharashtra, India
Introduction: Multiple myeloma is a plasma cell dyscrasia characterised by bone marrow infiltration by clonal plasma cells. Autologous stem cell transplantation(ASCT) is a worldwide accepted standard of care for all transplant eligible newly diagnosed multiple myeloma(TE-NDMM) patients.
Methods: This two centre retrospective study included 177 TE-NDMM patients who underwent ASCT between January 2000 to March 2023. Baseline disease characteristics and disease status prior to ASCT was recorded. All patients were staged by ISS staging. Parameters during ASCT like mucositis, ASCT stay and time to engraftment were noted. Response to ASCT, maintenance treatment, disease status at follow up and year of death were regularly updated till April 2023. As maintenance treatment was not practiced in our centres until 2015, survival outcomes for patients who received maintenance vs those who did not receive maintenance treatment was studied.
Results: The results were analysed from January 2020 to April 2023. 67% patients are males, 33% females. Mean age is 51 years. 44 (25%) patients underwent ASCT between 2000-2010 and 133 (75%) patients underwent ASCT between 2011 till March 2023. 26%, 30% and 44.5% patients belonged to ISS stage I, II and III respectively. 83% patients had CR/VGPR prior to ASCT. 63% patients underwent Early ASCT. Drugs in induction until 2010 included Vincristine, Doxorubicin, Melphalan, Thalidomide and Dexamethasone in various combinations, from 2011 drugs used are Bortezomib, Lenalidomide, Thalidomide, cyclophosphamide and dexamethasone in various combinations. 81% patients received GCSF for stem cell mobilisation. Plerixafor for stem cell mobilisation was practiced at our centres post 2016; 19% patients received it. Melphalan dose was 200mg/m2 in 66% patients. 89% patients had mucositis, of which 66% had grade II mucositis. 80% patients achieved neutrophil engraftment and 63% patients achieved platelet engraftment ≤14 days from the day of ASCT. Duration of stay during ASCT was ≤25 days in 72% patients. 3 patients had a treatment related mortality. 85 patients out of 177 received post transplant maintenance therapy. Lenalidomide maintenance was given to 67 (79%) patients, while Bortezomib was given to 10 patients (12%) with high risk cytogenetics. At the time of last follow up (25 Apr 2023), 117 (66.%) patients were alive and 53 (30%) had died; of which 1 died due to secondary AML and rest due to disease relapse. Out of the 117 patients alive, 84 (48%) are in CR/VGPR and 79 (45%) are on further lines of therapy. Overall survival of entire cohort is 14.29 years with 95% CI (12.972, 15.616). Overall survival for patients who did not receive maintenance regimen post ASCT is 14.85 years with 95% CI (13.248, 16.467). Overall survival for patients who received a maintenance regimen post ASCT is 8.49 years with 95% CI (5.097, 8.903).
Conclusions: Long term survival outcomes in transplant eligible NDMM are promising with low TRM and long term adverse effects.
