Autologous stem cell transplantation (ASCT) outcome for multiple myeloma in a tertiary referral centre in Malaysia
BLOOD CELL THERAPY / The official journal of APBMT
Introduction Multiple myeloma (MM) is characterized by the malignant proliferation of clonal plasma cells. It is believed that MM cases are preceded by a premalignant state of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma, for which the risk of progression to MM is approximately 1% and 10% per Blood Cell Therapy-The official journal of APBMT-Abstract Background: Multiple Myeloma(MM)is characterized by the presence of clonal plasma cells. These often result
... hese often result in complications including bone destruction, hypercalcemia, renal insufficiency, and anaemia. Induction with a triplet or quadruplet regimen followed by autologous stem cell transplantation(ASCT)has been the standard of care for transplant eligible patients to achieve durable remission. Purpose: This is a retrospective analytical study to determine the outcome of Multiple Myeloma patients who underwent ASCT in Ampang Hospital. Materials and Methods: We included a 5-year cohort of patients transplanted from 1st July 2014 to 30th June 2019. Data were obtained through electronic medical records. Prognostic factors for progression-free survival (PFS)and overall survival(OS)were analyzed using simple and multiple Cox proportional hazard regression analysis. All analyses were done using software R version 3.6.2 with validated statistical packages. Results: 139 patients were analyzed. The median age at transplant was 56 years old and 56.1% are males (n=78) . The most common subtype is IgG Kappa(n=67, 48.2%) . Only 93 patients in which the International Staging System(ISS)could be determined, and among them, 33.3% of patients(n=31)have advanced stage Ⅲ disease. The most common induction received before ASCT was a bortezomib based regimen and/or an immunomodulatory (IMiD) based regimen. 63.3% of patients achieved at least a very good partial response (VGPR) before ASCT. Most patients received myeloablative conditioning(MAC) (n=119, 85.6%) . The mean cell dose is 3.68×10 6 /kg. The median time to engraftment was 11 days for both platelet and absolute neutrophil count(ANC) . With the median follow-up of 17.3(range, 6.2-33.4)months, the median OS and PFS were not reached. The 1-year and 2-year PFS were 75%(95% CI 66-82%)and 52%(95% CI 42-62%) , respectively. The 1-year and 2-year OS were 82%(95% CI 74-88%)and 70%(95% CI 60-78%) , respectively. 6 patients(4.3%)had transplant-related mortality(TRM) . IgA subtype was found to adversely affect PFS. Maintenance therapy and the absence of renal impairment was associated with better PFS and OS. Discussion and Conclusions: Our study found that ASCT following induction treatment is safe and beneficial to achieve a deeper remission status. In our study, the addition of maintenance therapy is associated with an improved outcome in PFS and OS.