Outcomes of autologous stem cell transplant (ASCT) in multiple myeloma from a tertiary cancer center in India.

Abstract

e17003 Background: ASCT is part of standard treatment in multiple myeloma (MM).We report the results of such transplants and evaluate the role of prognostic factors if any in our patients. Methods: Sixty-one patients who underwent ASCT between June 1993 and March 2010 were included. Twenty four patients received VAD like regimen. Nineteen patients received novel agent based therapies. Ten patients underwent cyclophosphamide based mobilisation while only G-CSF based mobilisation done in 51 patients. Stem cells were harvested from peripheral blood in all patients. Melphalan was used at 200 mg/m2 in 24 patients. Prognostic factors evaluated for overall (OS) and progression-free survival (PFS) were baseline hemoglobin and albumin, ISS stage, disease status at day 100 post transplant, use of maintenance treatment post transplant, response to first line chemotherapy, use of novel agents before transplant and time to transplant from diagnosis. Results: Median age was 46 years. Median baseline haemoglobin (Hb) and albumin were 9.7 g/dl and 3.9 g/dl respectively. At the time of transplant 36% were in complete remission (CR), 5% in very good partial response (VGPR) and 28% in partial remission (PR). Median time to engraftment of neutrophils and platelets was 12 and 17 days respectively. Grade III–IV oral mucositis was seen in 35%. Transplant related mortality was 8.0 %. The 5 year overall survival (OS) and progression free survival (PFS) were 73% and 33% respectively. OS was better for patients with pre-transplant Hb greater than 9.7 g/dl (P= .04) and those who achieved CR at day 100 post transplant (P= .03). Patients who received maintenance therapy showed trend towards better OS (P= .07). PFS was better for patients with baseline albumin greater than 3.9g/dl (P = .043), Hb greater than 9.7 g/dl (P = .027) and early stage disease by ISS staging system (P=.001). Conclusions: Our study confirms that ASCT in such patients is safe and effective. Baseline albumin and Hb, ISS stage, day 100 disease response and use of maintenance treatment are important prognostic factors affecting survival.

Autologous Stem Cell Transplantation for Multiple Myeloma: Single Centre Experience from North India

“…We used VCD as the commonest induction regimens, whereas studies from India have also studied other induction regimens such as VAD and VD with good results [28,29]. The median duration of induction therapy/time to transplantation/ number of chemotherapy cycles is higher in our case series as compared to the average duration of the induction therapy in the west and is secondary to multiple socio-economic factors other than the medical reasons.…”

Stem Cell Transplantation in Multiple Myeloma: Very Much Alive and Kicking

“…There are few challenges for extending transplantation benefits which are specific to our country. The median time to transplantation still averages around ten months in our country from the time of diagnosis (Table 1); this could be attributed to the delayed decision making, poor education status and time taken for arranging finances [7,[9][10][11][12][13]. Lack of universal health care precludes many patients from the benefit of transplantation.…”