High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country

Abstract

We analyzed the results of 108 patients (78 males and 30 females) with multiple myeloma who underwent autologous stem cell transplantation (ASCT). The median age of patients was 52 years (range, 26-68 years). High-dose melphalan (200 mg/m 2 ) was used for conditioning. In all, 66 (61%) patients had evidence of chemo-sensitive disease before transplant. After ASCT 79.6% of patients responded: complete response 36%, very good partial response 29.6%, and partial response 13.9%. Complete response rate was higher for patients with chemo-sensitive disease; 33 of 66 (50.0%) patients achieved complete response compared with 7 of 42 (14.3%) patients with progressive disease, Po0.01. Response rates to ASCT were significantly low for patients with Hb p8.5 g/dl, serum albumin p3.3 g/dl, b-2 microglobulin 45.5 mg/l, International Staging System stage III at diagnosis and 412 months interval from diagnosis to transplant. Grade III-IV mucositis was the major regimen-related toxicity. At a median follow-up of 70 months, the median overall survival and event free survival (EFS) were 71 and 42 months, respectively. Estimated overall survival and EFS at 60 months were 54.4 ± 0.05% (s.e.) and 49.3 ± 0.05% (s.e.), respectively. Survival was significantly better for patients with pre-transplant chemosensitive disease and for those who achieved complete response following transplant.

Autologous Stem Cell Transplant in Multiple Myeloma: Excellent Safety and Efficacy Possible in a Non University Hospital of Developing Country

“…Our centre is performing autologous HSCT for multiple myeloma since year 2007 and our analysis of these 31 patients shows results comparable to international and other Indian centres results (Table 5) [12][13][14][15][16]. One Indian study described by Lalit Kumar et al showed median EFS & OS of 42 months & 71 months respectively.…”

“…Complications profile related to transplant is also comparable to other institutes data with exception of very low incidence of oral mucositis. Other studies have shown average 50 to 70% overall incidence of oral mucositis with 15 to 25% having severe form, however our data shows that only 3 (9.6%) patients had developed grade 2+3 oral mucositis [12][13][14][15][16]. Most important intervention which has helped in preventing oral mucositis in our patients is strictly following continuous ice sucking during Melphalan infusion, a proven intervention [11].…”

Bortezomib plus dexamethasone induction followed by autologous stem cell transplantation in multiple myeloma: A study from India

“…There is limited information regarding the efficacy, adverse effects or the long term complications of the induction regimens. 15 Therefore we sought to evaluate the efficacy and safety of the bortezomib plus dexamethasone as induction treatment followed by ASCT in newly diagnosed patients with MM.…”

Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India

“…Markov state transition probabilities of moving from one health state to another were computed using date on progression free survival, while the probability to die due to multiple myeloma was computed using the overall survival [18,19].…”