2015, Number 3
Survival free of progression and overall survival in patients with multiple myeloma submitted to autologous hematopoietic stem cells transplantation with schemes of conditioning alternative to endovenous melphalan
Full text
Language: Spanish
References: 17
Page: 198-209
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ABSTRACT
Background: Results in patients with multiple myeloma submitted to autologous hematopoietic stem pluripotential cells transplantation with conditioning with endovenous melphalan is widely documented; however, due to the endovenous presentation is not available in our media, it is necessary to know the results of alternative schemes about overall survival and survival free of progression.Objective: To know the overall survival and survival free of progression in patients with multiple myeloma submitted to autologous hematopoietic stem pluripotential cells transplantation with alternative schemes to endovenous melphalan attended at Hematology Service of National Medical Center 20 de Noviembre, Mexico City.
Patients and method: An observational, descriptive, cross-sectional, comparative, retrospective and retrolective study including patients 18-65 years old with diagnosis of multiple myeloma included in the program of autologous hematopoietic stem pluripotential cells transplantation and submitted to the procedure at Hematology Service of National Medical Center 20 de Noviembre, Mexico City from January 2000 to May 2014.
Results: 36 patients with multiple myeloma included in the program of autologous hematopoietic stem pluripotential cells transplantation were assessed. Mean time since diagnosis to transplantation was of 15.5 months (6-39 months); 58% received schemes of conditioning based on oral melphalan and 42%, based on busulphan. Myeloid graft was earlier (mean: 12 days) in group melphalan (p=0.04). Progression was observed in 7 days (2 in group melphalan and 5 in group busulphan). All mortality related to transplantation occurred in the group of busulphan (p=0.002). Survival free of progression was not reached in group of melphalan, while in group of busulphan it was of 96 months (p=0.77). Mean overall survival in group of melphalan was not reached, while in group of busulphan it was of 106 months (p .016). Toxicity was higher in group of busulphan in combined schemes with etoposide with severe mucositis in 55% of cases.
Conclusions: Despite of endovenous melphalan is to date the standard treatment preferred for conditioning in autologous hematopoietic stem pluripotential cells transplantation in patients with multiple myeloma, administration of oral melphalan offers encouraging results because at a follow-up of 55 months, only two progressions were documented at 12 and 27 months in our population; however, it is necessary a higher time of follow-up to generate solid conclusions. Despite the high toxicity observed in the group of busulphan, there was a significant difference about overall survival. Mortality related to treatment in our service is comparable to the results informed in literature. There was not found relation among variables studied and progression of the disease. Time between diagnosis and transplantation neither had effect.
REFERENCES
Bladé J, Rosinol L, Sureda A, Ribera JM, et al. High-dose theraphy intensification compared with continue standard chemotheraphy in multiple mieloma patients responding to the initial chemotheraphy: Long term results from a prospective randomized trial from the Spanish cooperative group PETHEMA. Blood 2005;106:3755-3759.
Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME, Abonour R, Siegel DS, Katz M, Greipp PR, Eastern Cooperative Oncology Group. Lenalidomide plus high-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: An open label randomised controlled trial. Lancet Oncol 2010;11:29-37.
Moreau P, Facon T, et al. Comparison of 200 mg/m2 melphalan and 8 Gy total body irradiation plus 140 mg/m2 melphalan as conditioning regimens for peripheral blood stem cell transplantation in patient with newly diagnosed multiple myeloma: Final analysis of the Intergroupe Francophone du Myélome 9502 randomized trial. Blood 2002;99:731-735.