Lebanese experience in treating multiple myeloma: A multicenter retrospective study.

Abstract

e20526 Background: Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of hematologic cancers. Novel agents and stem-cell transplantation are changing disease prognosis and patient’s survival. Our objective was to do a multicenter retrospective analysis in order to look at the effect of autologous bone marrow transplant on progression free survival (PFS) of multiple myeloma. Methods: 134 myeloma patients from different Lebanese centers were included in a retrospective, observational study. We reviewed disease characteristics of patients that were diagnosed with multiple myeloma between July 2002 and January 2018. Results: 62.7% were males and 33.7% females with a median age of 65.5 years at diagnosis. 37 patients had a Karyotype on diagnosis, of which 21.6% were normal and 78.4% had abnormal cytogenetics including loss of chromosome Y, hypoploidy and tetraploidy. Regarding the M component, we had 52.2% IgG, 17.9% IgA, 1.4% IgM, 11.2% Kappa, 5.2% lambda, and 0.7% had 2 spikes M and G. 53.7% patients had bony lesions on diagnosis, 16.4% didn’t and 29.9% patients were unknown. According to ISS staging, 11.9% patients had an ISS of 1, 11.2% an ISS of 2, and 23.9% an ISS of 3. The majority (40.3%) were transplanted, 24.6% were not and 6.7% were still on induction therapy at the time of data cutoff [31/12/2018]. 28.4% had an unknown transplant status. 6.7% patients were diagnosed based on atypical plasmacytosis, 22.4% had monoclonal spike and 67.8% had multiple diagnostic modalities including immunofixation and urine studies. 29.1% of patients had plasmocytes between 10 and 60% and 9% had more than 60% plasmocytes on bone marrow at diagnosis. VCD was the main induction protocol used (38.8%) followed by VTD (14.2%) and VRD (9%). For the transplant group, 11.7% were in CR, 23.5% in VGPR and 19.6% were in PR before high dose melphalan. No death occurred during induction. 126 patients were still alive and taking treatment at the time of data cutoff. Mean PFS was 49.69 months (± 32.83) and 22.28 months (± 16.36) in the transplant and non-transplant group respectively (p = 0.001). Conclusions: Few previous reports described transplant data in Lebanese myeloma patients. As in the international data, we found a significant progression free survival in the transplanted group compared to the non-transplanted one.

Management of Multiple Myeloma in the Middle East: Unmet Needs, Challenges and Perspective

“…Current real-world evidence shows that triplet therapy followed by autologous hematopoietic stem cell transplantation, consolidation and maintenance for fit responder patients remains the backbone of MM treatment in Lebanon, while novel regimens are being explored whenever possible [ 9 ]. Fit patients might even receive quadruplet regimens, while adjusted intensity regimens are optimal for frail elderly patients [ 10 ].…”

“…For instance, Lebanon faces the lack of epidemiological, etiological, and clinical studies in the context of MM. While scant, published data reveal the increasing trend in MM incidence [ 7 ], the poor survival of elderly patients, and the need for less toxic alternative treatment options [ 8 , 9 ]. With this perspective, areas of current practice that are the focus of considerable debate and constitute a challenge/gap in the management of MM in the Middle East are explored, with a special focus on the Lebanese situation.…”