Treatment of multiple myeloma patients with autologous stem cell transplantation — a fresh analysis

Abstract

Patients with multiple myeloma (MM) treated with conventional chemotherapy have an average
survival of approximately three years. High dose chemotherapy followed by autologous stem cell transplantation
(ASCT), first introduced in the mid-1980s, is now considered the standard therapy for almost all patients
with multiple myeloma, because it prolongs overall survival and disease free survival. Between November 1997
and October 2006, 122 patients with MM (58 females, 64 males, median age 51.0 years [± 7.98] range: 30–66
years) were transplanted in the Department of Hematooncology and Bone Marrow Transplantation at the Medical
University of Lublin: 47 patients were in complete remission or in unconfirmed complete remission,
66 patients were in partial remission, and nine had stable disease. Of these, there were 95 patients with IgG myeloma,
16 with IgA myeloma, one with IgG/IgA, one with IgM myeloma, five with non secretory type, two with
solitary tumor and two with LCD myeloma. According to Durie-Salmon, 62 patients had stage III of the disease,
46 had stage II and four had stage I. Most patients (69/122) were transplanted after two or more cycles of
chemotherapy, 48 patients were transplanted after one cycle of chemotherapy, one patient after surgery and rtg-
-therapy and four patients had not been treated. In mobilisation procedure, the patients received a single infusion
of cyclophosphamide (4–6 g/m²) or etoposide 1.6 g/m² followed by daily administration of G-CSF until the
peripheral stem cells harvest. The number of median harvest sessions was 2.0 (± 0.89) (range: 1–5). An average
of 7.09 (± 33.28) × 106 CD34+ cells/kg were collected from each patient (range: 1.8–111.0 × 106/kg). Conditioning
regimen consisted of high dose melphalan 60–210 mg/m² without TBI. An average of 3.04 (± 11.59) × 106
CD34+ cells/kg were transplanted to each patient. Fatal complications occured in four patients (treatment-
-related mortality = 3.2%). In all patients there was regeneration of hematopoiesis. The median number of days
for recovery to ANC > 0.5 × 10⁹/l was 13 (± 4.69) (range: 10–38) and platelets recovery to > 50 × 10⁹/l was 25
days (± 11.65) (range: 12–45). Median time of hospitalization was 22 days (± 7.14) (range: 14–50). Patients
were evaluated on day 100 after transplantation: 74.9% achieved CR and nCR, 14.3% were in PR, 5.4% had SD
and 5.4% had progressed. Median of OS was 45 months (± 30.67). OS at 3-years was 84% and at 7-years 59%.
Median PFS was 25 months (± 26.13). PFS at 3-years was 68%, and at 7-years was 43%. At present (November
2009) 52 patients (42%) are still alive. High-dose chemotherapy followed by autologous stem cell transplantation
is a valuable, well tolerated method of treatment for patients with MM that allows the achievement of long-
-lasting survival. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 2, pp. 248–254)