Background:Early mortality (EM) in multiple myeloma (MM) ranges from 4% to 25% mostly depending on the patients included and on treatment options. EM tends to be lower in clinical trials including younger, transplant‐eligible patients or in bortezomib‐ and lenalidomide‐based regimens in comparison with elderly patients and conventional chemotherapy treatment.Aims:To estimate risk factors associated with EM in patients with newly diagnosed MM.MethodsPatients with newly diagnosed MM were included into the study (from Jan 2013 to Feb 2019). EM was defined if it occurred within 1 year of entry into the study. Adverse cytogenetic abnormalities were specified as gain(1q), t(4;14), t(14;16), t(14;20) or del(17p).Results:A total of 174 patients with newly diagnosed MM (82 male, 92 female; median age 61 years) were involved in the study. Follow‐up period was 1‐71.4 months (median 8 months). The majority of patients developed an advanced stage of disease (Duriе‐Salmon stage 3–141 (81.1%), ISS stage 3–99 (56.9%)). All patients received chemotherapy regimens containing proteasome inhibitors as first‐line therapy and immunomodulatory drugs, intensive and conventional chemotherapy regimens as second‐ or next‐line therapy. During follow‐up period fatal outcome was observed in 45 (25.9%) of 174 patients, of them 16 (9.2%) patients with EM. Median early mortality was 4.7 months. The age of patients with EM and patients survived > 1 year was comparable (median age 64.5 vs. 61, respectively). A larger proportion of patients with EM had Durie‐Salmon stage 3 (93.8% vs 79.7%), ISS stage 3 (75.0% vs 55.1%). Fish in situ hybridization analysis was conducted in 126 (72.4%) patients, adverse cytogenetic abnormalities were present in 4/8 (50.0%) patients with EM and 33/118 (27.9%) patients survived >1 year. Risk factors assotiated with EM were ECOG performance status ≥ 3 score (87.5% vs 40.5%, p = 0.0003), C‐reactive protein level > 10 mg/L (62.5% vs 26.6%, p = 0.007), high lactic acid dehydrogenase activity (81.3% vs 46.2%, p = 0.008), platelet count < 150 × 109/L (43.8% vs 18.9%, p = 0.047) (tab.). For the 16 patients with EM, 11 (68.8%) of deaths were related to MM progression, 4 (25.0%) were due to infections and 1 (6.2%) ‐ heart failure.Summary/Conclusion:EM in patients with newly diagnosed MM was 9.2%. Risk factors associated with EM were poor performance status, elevated serum LDH activity, low platelet count, high serum C‐reactive protein.image

Background: In the era of novel anti-myeloma agents and monoclonal antibodies (daratumumab) and due to their high cost, earlier low cost regimens (VAD or CyBorD) may be used. Aims: to compare outcome of treatment of CyBorD versus VAD regimens in multiple myeloma Methods: This cohort study included 89 MM patients treated at National Cancer Institute (NCI), Cairo, Egypt from January 2011 to December 2015. All patients were evaluated clinically and laboratory for different responses with either lines of treatment (VAD versus CyBorD), and correlated with different survival parameters; progression free (PFS), disease free (DFS), and overall survival (OS), and clinico-pathologic factors. Results: The median age of patients was 54 years (32-76), with male predominance (male to female ratio 1.87:1). The most common presenting symptoms were bony pains (44.9%) followed by bony masses (22.5%), fractures

CR of the disease (median follow-up of 80 months). In 3/14 pts had early relapses. From 89/126 pts, who completed therapy only R-CHOP and maintenance therapy R, 50/89 (56%) pts have developed recurrence of the disease. 39/89 (44%) pts have CR (the median follow-up of 80 months). In 11/203 (5 %) patients there was a resistant course of the tumor. 5-year OS in the R-B group is higher than in the R-CHOP group: 92% (Standard Error, ± 4%) vs. 87% ( ± 3%). Frequency analysis shows that the number of deaths in different regimens differ statistically significantly: 4/62 (6.5%, R-B) vs. 21/105 (20.0%, R-CHOP), Fisher's exact test, p = 0.05; relative risk (R-CHOP/R-B): 2.8 (95% CI: 0.9-7.7). Summary/Conclusion: In the analysis of 203 pts, independent predictors of OS and EFS in FL were determined. The high risk of adverse events associated with 3A cytological type of tumor. R-B is more effective in FL of 1-2 cytological type than 3A. In the presence of bulky and FLIPI 3-5 relapse occurs three times more often after R-CHOP (76%) than after high-dose therapy. R-B effectively sanitizes the bone marrow allows you to perform the successful mobilization of blood stem cells before autoSCT. Analysis of the results of immunohistochemistry in patients resistant to therapy showed that in all cases the tumor expressed CD20, in 8/11(73%) cases -CD10, in 7/11(64%) cases -BCL-2, and in one case(1/11 (9%) -there was a peripheral ''aureole'' of T-lymphocytes, framing tumor nodules, which have a deterrent effect.

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