Autologous Stem Cell Transplantation in Myeloma: the St James's Hospital Experience, 1997-2003

Overview

Journal Ir J Med Sci

Specialty General Medicine

Date 2005 Aug 13

PMID 16094909

Authors

P J Hayden

A ODriscoll

N Gardiner

R Swords

J Sargent

F Ni Ainle

A Fortune

P T Murphy

M Leahy

F Jackson

M Ryan

B Hennessy

M Cahill

G M Crotty

H Enright

E Conneally

E Vandenberghe

S R McCann

P V Browne

Affiliations

Soon will be listed here.

Abstract

Background: High-dose treatment with autologous stem cell transplantation (ASCT) has become the standard of care for patients with myeloma below the age of 65 years.

Aims: We report an audit of 60 patients (median age: 52.5 years) who underwent ASCT in the National Bone Marrow Transplant centre in St James's Hospital in Dublin between 1997 and 2003 inclusive.

Methods: Clinical and laboratory data were retrieved from patient medical records and hospital information management systems.

Results: Thirty-six patients had IgG, 11 IgA, 1 IgD, 9 light chain and 3 non-secretory MM. Fifty-seven (95%) patients received anthracycline-corticosteroid combination chemotherapy prior to autografting. There was no transplant-related mortality (TRM). Complete (CR) and Partial Responses (PR) were seen in 16 (29.6%) and 29 (53.7%) of those evaluable (n = 54 (90%)). The actuarial Progression-Free (PFS) and Overall Survival (OS) rates at five years are 13% and 55% respectively.

Conclusion: Centre outcome is comparable to published international series and supports the use of ASCT in the treatment of this malignancy.

References

Stewart A, Vescio R, Schiller G, Ballester O, Noga S, Rugo H . Purging of autologous peripheral-blood stem cells using CD34 selection does not improve overall or progression-free survival after high-dose chemotherapy for multiple myeloma: results of a multicenter randomized controlled trial. J Clin Oncol. 2001; 19(17):3771-9. DOI: 10.1200/JCO.2001.19.17.3771. View

Bensinger W, Rowley S, Demirer T, Lilleby K, Schiffman K, Clift R . High-dose therapy followed by autologous hematopoietic stem-cell infusion for patients with multiple myeloma. J Clin Oncol. 1996; 14(5):1447-56. DOI: 10.1200/JCO.1996.14.5.1447. View

McElwain T, Powles R . High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet. 1983; 2(8354):822-4. DOI: 10.1016/s0140-6736(83)90739-0. View

Badros A, Barlogie B, Siegel E, Morris C, Desikan R, Zangari M . Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol. 2001; 114(3):600-7. DOI: 10.1046/j.1365-2141.2001.02976.x. View

Lee C, Zangari M, Barlogie B, Fassas A, van Rhee F, Thertulien R . Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant. Bone Marrow Transplant. 2004; 33(8):823-8. DOI: 10.1038/sj.bmt.1704440. View

Lenhoff S, Hjorth M, Holmberg E, Turesson I, Westin J, Nielsen J . Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Nordic Myeloma Study Group. Blood. 1999; 95(1):7-11. View

Tricot G, Jagannath S, Vesole D, Nelson J, Tindle S, Miller L . Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients. Blood. 1995; 85(2):588-96. View

Badros A, Barlogie B, Siegel E, Roberts J, Langmaid C, Zangari M . Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol. 2001; 114(4):822-9. DOI: 10.1046/j.1365-2141.2001.03033.x. View

Child J, Morgan G, Davies F, Owen R, Bell S, Hawkins K . High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003; 348(19):1875-83. DOI: 10.1056/NEJMoa022340. View

10.

Anagnostopoulos A, Aleman A, Yang Y, Donato M, Weber D, Champlin R . Outcomes of autologous stem cell transplantation in patients with multiple myeloma who received dexamethasone-based nonmyelosuppressive induction therapy. Bone Marrow Transplant. 2004; 33(6):623-8. DOI: 10.1038/sj.bmt.1704398. View

11.

. Diagnosis and management of multiple myeloma. Br J Haematol. 2001; 115(3):522-40. DOI: 10.1046/j.1365-2141.2001.03206.x. View

12.

Singhal S, Mehta J, Desikan R, Ayers D, Roberson P, Eddlemon P . Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med. 1999; 341(21):1565-71. DOI: 10.1056/NEJM199911183412102. View

13.

Barlogie B, Shaughnessy J, Tricot G, Jacobson J, Zangari M, Anaissie E . Treatment of multiple myeloma. Blood. 2003; 103(1):20-32. DOI: 10.1182/blood-2003-04-1045. View

14.

Rosen L, Gordon D, Kaminski M, Howell A, Belch A, Mackey J . Long-term efficacy and safety of zoledronic acid compared with pamidronate disodium in the treatment of skeletal complications in patients with advanced multiple myeloma or breast carcinoma: a randomized, double-blind, multicenter, comparative trial. Cancer. 2003; 98(8):1735-44. DOI: 10.1002/cncr.11701. View

15.

Nadal E, Gine E, Blade J, Esteve J, Rosinol L, Fernandez-Aviles F . High-dose therapy/autologous stem cell transplantation in patients with chemosensitive multiple myeloma: predictors of complete remission. Bone Marrow Transplant. 2004; 33(1):61-4. DOI: 10.1038/sj.bmt.1704313. View

16.

Barlogie B, Jagannath S, Desikan K, Mattox S, Vesole D, Siegel D . Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood. 1998; 93(1):55-65. View

17.

Morgan G, Davies F, Linet M . Myeloma aetiology and epidemiology. Biomed Pharmacother. 2002; 56(5):223-34. DOI: 10.1016/s0753-3322(02)00194-4. View

18.

Catley L, Anderson K . Strategies to improve the outcome of stem cell transplantation in multiple myeloma. Hematol J. 2004; 5(1):9-23. DOI: 10.1038/sj.thj.6200322. View

19.

. Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol. 1998; 16(12):3832-42. DOI: 10.1200/JCO.1998.16.12.3832. View

20.

. Report on the second myelomatosis trial after five years of follow-up. Medical Research Council's Working Party on Leukaemia in Adults. Br J Cancer. 1980; 42(6):813-22. PMC: 2010573. DOI: 10.1038/bjc.1980.328. View