High-dose chemotherapy following autologous hematopoietic stem cell transplantation for multiple myeloma in the real world setting. Single-center experience

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Abstract


Aim. To assess the long-term results of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) for multiple myeloma (MM) in the real setting and influence of different factors on the results.

Materials and methods. From 2006 till 2018 in Pirogov’s Center were performed 205 autoHSCT for patients with MM, aged between 31–72 years (median 55). 55 (26.8%) autoHSCT were tandem. The study population consisted of 45% men and 55% women. Median follow up was 75 months. For the majority of patients autoHSCT was performed after achieving at least partial response according to the IMWG criteria. For less than 9% patients, autoHSCT was done for chemo refractory disease as a salvage therapy. Most of the patients – 179 (87.4%) were treated using melphalan-based conditioning regimens (140 or 200 mg/m2). Initial staging according to ISS was done for less than 30% and to R-ISS – less than 5% patients. No transplant-related mortality till D + 100 was registered. 186 patients were included in the final analysis.

Results. The 5-year OS and PFS were 73% and 34%, respectively, that corresponds with international data. For patients, younger than 60, 5-year OS was 82%; for patients older than 60, it was 49% (p<0.05). For tandem autoHSCT, 5-year PFS was 44%; for single autoHSCT – 26% (p<0.05). 5-year PFS after autoHSCT was significantly higher in patients with complete and stringent complete response after autoHSCT (44%) in comparison with the group with partial and very good partial response (77%). Sex, response before and after autoHSCT, immunomodulatory drugs in induction, number of prior lines of induction therapy, conditioning regimen and maintenance therapy had no influence on OS. PFS had the same tendencies, except tumor response after autoHSCT.

Conclusion. In a real setting, we recommend tandem autoHSCT for all eligible patients with chemosensitive disease, despite the depth of response and induction therapy. Patients younger than 60 and patients with complete of greater response after autoHSCT, benefit from the autoHSCT most. Implementation of total cytogenetic testing according to the R-ISS is of a great value for further development of autoHSCT for MM in Russia.


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About the authors

Nikita E. Mochkin

Pirogov National Medical Surgical Center

Author for correspondence.
Email: nickmed@yandex.ru
ORCID iD: 0000-0001-5622-0828

Russian Federation, Moscow

Cand. Sci. (Med.)

Vladislav O. Sarzhevskiy

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru
ORCID iD: 0000-0001-7164-6595

Russian Federation, Moscow

D. Sci. (Med.)

Julia N. Dubinina

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru

Russian Federation, Moscow

hematologist

Elena G. Smirnova

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru
ORCID iD: 0000-0003-1114-2592

Russian Federation, Moscow

hematologist

Denis A. Fedorenko

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru

Russian Federation, Moscow

D. Sci. (Med.)

Anna E. Bannikova

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru
ORCID iD: 0000-0003-3697-6876

Russian Federation, Moscow

hematologist

Dina S. Kolesnikova

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru

Russian Federation, Moscow

Cand. Sci. (Med.)

Vladimir S. Bogatyrev

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru

Russian Federation, Moscow

hematologist

Anastasia A. Samoylova

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru
ORCID iD: 0000-0002-3876-3869

Russian Federation, Moscow

hematologist

Nikolay M. Faddeev

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru

Russian Federation, Moscow

hematologist

Vladimir Ya. Melnichenko

Pirogov National Medical Surgical Center

Email: nickmed@yandex.ru
ORCID iD: 0000-0002-6728-6264

Russian Federation, Moscow

D. Sci. (Med.)

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Overall survival (OS) of patients with multiple myeloma (MM) after high-dose chemotherapy with autologous peripheral blood progenitor cells transplantation (HDCT + auto-PBPC transplantation) (n=186).

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2.
Fig. 2. Progression-free survival (PFS) of patients with MM after HDCT + auto-PBPC transplantation (n=186).

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3.
Fig. 3. OS of patients with MM after HDCT + auto-PBPC transplantation according to age (n=186).

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4.
Fig. 4. PFS of patients with MM after HDCT + auto-PBPC transplantation according to age (n=186).

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5.
Fig. 5. OS of patients with MM after HDCT + auto-PBPC transplantation according to the type of transplantation (single or tandem) (n=186).

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6.
Fig. 6. PFS of patients with MM after HDCT + auto-PBPC transplantation according to the type of transplantation (single or tandem) (n=186).

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7.
Fig. 7. PFS of patients with MM after HDCT+ auto-PBPC transplantation according to the tumor response rate recorded after auto-PBPC transplantation (n=186).

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