Safety and efficacy of autologous stem cell transplantation in dialysis-dependent myeloma patients-The DIADEM study from the chronic malignancies working party of the EBMT.
Anna Waszczuk-Gajda
(1)
,
Luuk Gras
,
Liesbeth C. de Wreede
(2)
,
Tiarlan Sirait
,
Arpad Illes
(3)
,
Zubeyde Nur Ozkurt
(4)
,
John A. Snowden
(5)
,
Mutlu Arat
,
Claude Eric Bulabois
(6)
,
Judith Niederland
(7)
,
Matjaz Sever
(8)
,
Shankara Paneesha
(9)
,
Victoria Potter
(10)
,
Alain Gadisseur
(11)
,
Thomas Chalopin
(12)
,
Gwendolyn van Gorkom
(13)
,
Joaquin Martinez López
(14)
,
Tessa Kerre
(15)
,
Joanna Drozd-Sokolowska
(1)
,
Kavita Raj
(10)
,
Patrick J. Hayden
(16)
,
Meral Beksac
(17)
,
Ibrahim Yakoub-Agha
(18)
,
Donal P. Mclornan
(19)
,
Stefan O. Schonland
(20)
1
Medical University of Warsaw - Poland
2 LUMC - Leiden University Medical Center
3 University of Debrecen
4 Gazi University
5 Sheffield Children's NHS Foundation Trust
6 UGA - Université Grenoble Alpes
7 Helios Klinikum [Erfurt]
8 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
9 University Hospitals Birmingham [Birmingham, Royaume-Uni]
10 KCH - King's College Hospital
11 UZA - Antwerp University Hospital [Edegem]
12 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
13 GROW - School for Oncology and Developmental Biology [Maastricht]
14 Hospital Universitario 12 de Octubre [Madrid]
15 UGENT - Universiteit Gent = Ghent University = Université de Gand
16 Trinity College Dublin
17 Ankara University School of Medicine [Turkey]
18 LIRIC - Lille Inflammation Research International Center - U 995
19 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
20 Heidelberg University Hospital [Heidelberg]
2 LUMC - Leiden University Medical Center
3 University of Debrecen
4 Gazi University
5 Sheffield Children's NHS Foundation Trust
6 UGA - Université Grenoble Alpes
7 Helios Klinikum [Erfurt]
8 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
9 University Hospitals Birmingham [Birmingham, Royaume-Uni]
10 KCH - King's College Hospital
11 UZA - Antwerp University Hospital [Edegem]
12 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
13 GROW - School for Oncology and Developmental Biology [Maastricht]
14 Hospital Universitario 12 de Octubre [Madrid]
15 UGENT - Universiteit Gent = Ghent University = Université de Gand
16 Trinity College Dublin
17 Ankara University School of Medicine [Turkey]
18 LIRIC - Lille Inflammation Research International Center - U 995
19 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
20 Heidelberg University Hospital [Heidelberg]
Résumé
The role of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in the treatment of myeloma (MM) patients with severe and/or dialysis-dependent renal impairment remains uncertain. We report on the outcomes of 110 patients (median age 57 years) who had become dialysis-dependent pre-ASCT and who underwent a first ASCT between 1997 and 2017. Sixty-three (57%) patients had light chain MM. All patients required dialysis (94% hemodialysis and 6% peritoneal). Forty-four of 71 (62%) patients received bortezomib-based induction regimens and 42 (39%) patients had achieved at least a very good partial response (VGPR) pre-ASCT. Melphalan dosing was as follows: ≤140 mg/m2 (82%), and >140 mg/m2 (18%). The median PFS after ASCT was 35 months (95% CI: 21.5–42.2) and the median OS 102 months (95% CI: 70.4–129.1). At 1, 2, and 5 years after ASCT, 8% (95% CI 3–14%), 13% (6–20%), and 20% (12–29%) of patients, respectively, had achieved dialysis independence. In multivariate analyses of OS and PFS including age at ASCT, response at ASCT, and year of ASCT, younger age at ASCT and better response at ASCT (CR/VGPR/PR vs. MR/SD/progression) were significantly associated with better OS and PFS.