Clinical Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients: A 5-year Experience from a Single Centre in North India

Nitin Sood; Aseem Kumar Tiwari; Swati Pabbi; Roshan Dikshit; Prerna Singh; Amrita Ramaswami; Dheeraj Gautam; Manish Kumar Singh

doi:10.1055/s-0042-1748184

South Asian Journal of Cancer, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(02): 185-189
DOI: 10.1055/s-0042-1748184

Original Article

Lymphoma and Myeloma

Clinical Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients: A 5-year Experience from a Single Centre in North India

Authors

Nitin Sood

¹Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
Aseem Kumar Tiwari

²Department of Transfusion Medicine and Immunohematology, Medanta-The Medicity, Gurgaon, Haryana, India
Swati Pabbi

²Department of Transfusion Medicine and Immunohematology, Medanta-The Medicity, Gurgaon, Haryana, India
Roshan Dikshit

¹Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
Prerna Singh

¹Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
Amrita Ramaswami

³Department of Hemato-Oncology and BMT, Artemis Hospital, Gurgaon, Haryana, India
Dheeraj Gautam

⁴Department of Histopathology, Medanta-The Medicity, Gurgaon, Haryana, India
Manish Kumar Singh

⁵Department of Bio-Statistician, Medanta-The Medicity, Gurgaon, Haryana, India

Abstract

Swati Pabbi

Introduction Multiple myeloma (MM) forms a significant proportion of hematological malignancies. Autologous transplantation continues to be an effective consolidation strategy in resource-restricted settings such as India.

Objectives The main objective of the study was to analyze the clinical outcomes of autologous hematopoietic stem cell transplant (HSCT) in MM patients in a single tertiary care center in north India over a period of 5 years.

Materials and Methods This retrospective observational study was conducted in a tertiary care center in north India. Data of all MM patients who underwent HSCT between January 2014, and December 2018, were analyzed. The outcome of HSCT was investigated in terms of transplant-related mortality (TRM), progression-free survival (PFS), overall survival (OS), and relapse. PFS and OS were calculated by Kaplan–Meier method and differences between the groups were tested for statistical significance using the two-tailed log-rank test. Life-table method was used for the estimation of survival rate at 1, 3, 5, and 6 years.

Results Patient characteristics and survival post-transplant was similar to other published Indian studies. In total, 378 patients were diagnosed with MM in our hospital between 2014 and 2018. One hundred ninety-three patients were found to be eligible for autologous HSCT, out of which 52 ended up having a transplant giving us a high percentage (26.9%) of patients receiving a transplant in our setting. Transplant-related mortality (TRM) was nil in the present study. The mean PFS and OS were 62.8 and 70.1 months, respectively. The mean PFS and OS rates at 5 years were 75.3% and 84.2%, respectively. The average cost estimate of HSCT in our setting was 7.2 lakh Indian national rupees.

Conclusion Autologous HSCT is a safe procedure with nil 100-day mortality in present series. Moreover, considering the cost of novel agents, autologous transplant remains a cost-effective way for prolonging remission and time-to-next treatment in India.

Keywords

myeloma - multiple myeloma - autologous transplant - hematopoietic stem cell transplant

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Referenzen

References
1 Ludwig H, Durie BG, Bolejack V. et al. Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 2008; 111 (08) 4039-4047
2 Kumar SK, Rajkumar SV, Dispenzieri A. et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111 (05) 2516-2520
3 Cavo M, Baccarani M. The changing landscape of myeloma therapy. N Engl J Med 2006; 354 (10) 1076-1078
4 Attal M, Harousseau JL, Stoppa AM. et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med 1996; 335 (02) 91-97
5 Child JA, Morgan GJ, Davies FE. et al; Medical Research Council Adult Leukaemia Working Party. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348 (19) 1875-1883
6 Gupta S, Kumar L, Raju GM, Kochupillai V, Shukla DK. Autologous bone marrow/stem cell transplantation: initial experience at a north Indian referral centre. Natl Med J India 2000; 13 (02) 61-66
7 Gil-Sierra MD, Gimeno-Ballester V, Fénix-Caballero S, Alegre-Del Rey EJ. Network meta-analysis of first-line treatments in transplant-ineligible multiple myeloma patients. Eur J Haematol 2020; 105 (01) 56-65
8 Kumar S, Paiva B, Anderson KC. et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2016; 17 (08) e328-e346
9 Kumar L, Ramavath D, Kataria B. et al; for AIIMS Myeloma Group. High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome. Indian J Med Res 2019; 149 (06) 730-739
10 Aggarwal M, Agrawal N, Yadav N. et al. Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma. Ann Hematol 2018; 97 (10) 1869-1877
11 Kumar L, Verma R, Radhakrishnan VR. Recent advances in the management of multiple myeloma. Natl Med J India 2010; 23 (04) 210-218
12 Malhotra P, Yanamandra U, Khadwal A. et al. Autologous stem cell transplantation for multiple myeloma: single centre experience from North India. Indian J Hematol Blood Transfus 2018; 34 (02) 261-267
13 Kulkarni U, Devasia AJ, Korula A. et al. Clinical outcomes in multiple myeloma post-autologous transplantation—a single centre experience. Indian J Hematol Blood Transfus 2019; 35 (02) 215-222
14 Kumar L, Boya RR, Pai R. et al. Autologous stem cell transplantation for multiple myeloma: Long-term results. Natl Med J India 2016; 29 (04) 192-199
15 Gokarn A, Bonda A, Mathew L. et al. High dose chemotherapy with autologous stem cell transplantation for multiple myeloma: outcomes at Tata Memorial Centre. Clin Lymphoma Myeloma Leuk 2017; 17: e126
16 Stadtmauer EA, Pasquini MC, Blackwell B. et al. Comparison ofautologous hematopoietic cell transplant (autoHCT), bortezomib, lenalidomide (len) anddexamethasone (RVD) consolidation with len maintenance (ACM), tandem autohct with lenMaintenance (TAM) and autohct with len maintenance (AM) for up-front treatment of patients withmultiplemyeloma (MM): primary results from the randomized phase III trial of the Blood and MarrowTransplant Clinical TrialsNetwork (BMT CTN 0702–StaMINA Trial). Blood 2016; 128: LBA–1
17 Goldschmidt H, Lokhorst HM, Mai EK. et al. Bortezomib before and after high-dose therapy in myeloma: long-term results from the phase III HOVON-65/GMMG-HD4 trial. Leukemia 2018; 32 (02) 383-390
18 Zhang S, Kulkarni AA, Xu B. et al. Bortezomib-based consolidation or maintenance therapy for multiple myeloma: a meta-analysis. Blood Cancer J 2020; 10 (03) 33
19 Bagal BP, Khattry N, Dongre A. et al. Outcomes of autologous stem cell transplant (ASCT) in multiple myeloma from a tertiary cancer center in India. J Clin Oncol Conf 2012; 30 (15 suppl. 1): e17003