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Zhang Y, Pan J, Kang H, Peng S, Tung TH, Shen B. Prognosis of concurrent renal impairment at diagnosis of multiple myeloma: a systematic review. Ann Med 2024; 56:2380301. [PMID: 39034813 PMCID: PMC11265304 DOI: 10.1080/07853890.2024.2380301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/27/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Multiple myeloma is a malignant tumour of the blood in which abnormal proliferation of plasma cells leads to bone destruction, renal impairment, anaemia, and hypercalcaemia. Renal impairment caused by multiple myeloma is a common and serious condition; however, the prognosis of multiple myeloma at the time of diagnosis remains unclear. METHOD We conducted searches for literature in PubMed, Web of Science, Cochrane, Embase, CNKI, Wanfang, and VIP databases up to 30 April 2023. Progression-free survival and overall survival with and without renal impairment at the time of multiple myeloma diagnosis were compared, and prognostic indicators were analysed. RESULTS Six studies were finally included. Among patients with multiple myeloma, 319 had renal impairment, and 1166 had no renal impairment. Compared to the control group, no significant difference was observed in overall or progression-free survival in patients with multiple myeloma complicated with renal impairment. CONCLUSION The limited low-quality evidence available does not support an association between prognosis and multiple myeloma complicated by kidney injury.
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Affiliation(s)
- Yanjie Zhang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Juan Pan
- Department of Clinical Laboratory, Taizhou Hospital, Zhejiang University, Linhai, China
| | - Haixin Kang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Shuotao Peng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Bo Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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Garderet L, Ouldjeriouat H, Bekadja MA, Daguenet E, Bigot N, Vincent L, Roos-Weil D, Vignon M, Ikhlef S, Abraham J, Escoffre-Barbe M, Lioure B, Nacer RA, Lafon I, Mariette C, Karlin L, Morel P, Gilis L, Le Ray E, Blouet A, Nguyen Quoc S, Boffa JJ, Ronco P, Lambert J, Cornillon J. Low non-relapse mortality and good haematological and renal responses after autologous haematopoietic stem cell transplantation in multiple myeloma patients with renal insufficiency at transplant: A prospective Société Francophone de Greffe de Moelle-Thérapie Cellulaire observational study. Br J Haematol 2024; 204:1450-1458. [PMID: 37953476 DOI: 10.1111/bjh.19163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
High-dose melphalan followed by autologous haematopoietic stem cell transplantation is widely used in newly diagnosed multiple myeloma (MM) patients as upfront therapy. However, the safety and efficacy of transplantation in patients with renal insufficiency (RI) are controversial. We followed a multicentre (16 SFGM-TC centres) prospective cohort of 50 newly diagnosed MM patients with a serum creatinine clearance of <40 mL/min at transplantation. Patients received a recommended dose of melphalan of 140 mg/m2. The primary end-point was the non-relapse mortality at Day 100. One death occurred during the first 100 days post-transplant. The median time to neutrophil engraftment was 12 days and to platelet engraftment was 13 days. The haematological response improved in 69% of patients, with best responses from partial response (PR) to very good partial response (VGPR) (10%), from PR to complete response (CR)/stringent complete response (sCR) (16%), from VGPR to CR/sCR (39%) and from CR to sCR (2%). At 2 years, the overall survival was 84%, the progression-free survival was 70% and the cumulative incidence of relapse was 20%. The renal response improved in 59% of patients, with the best renal responses post-transplant being minimal (9%), partial (2%) and complete (48%). Autologous transplantation was safe and effective in myeloma patients with RI at transplant.
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Affiliation(s)
- Laurent Garderet
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Hafida Ouldjeriouat
- Department of Hematology and Cell Therapy, EHU 1st Novembre 1954 Bir el Djir Usto, University Ahmed Benbella 1, Oran, Algeria
| | - Mohamed-Amine Bekadja
- Department of Hematology and Cell Therapy, EHU 1st Novembre 1954 Bir el Djir Usto, University Ahmed Benbella 1, Oran, Algeria
| | - Elisabeth Daguenet
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint-Etienne, Saint-Etienne, France
| | - Noemie Bigot
- Biostatistics Department, University of Paris, AP-HP, Saint Louis Hospital, Paris, France
| | - Laure Vincent
- Department of Hematology, Montpellier University Hospital, Montpellier, France
| | - Damien Roos-Weil
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | | | - Souhila Ikhlef
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | - Julie Abraham
- Clinical Hematology Service, CHU Limoges, Limoges, France
| | | | - Bruno Lioure
- Département Hematologie, ICANS, Strasbourg, France
| | | | - Ingrid Lafon
- Hematology Department, Institut de Cancerologie de Bourgogne, Dijon, France
| | - Clara Mariette
- Service d'Hématologie, CHU de Grenoble, Grenoble, France
| | - Lionel Karlin
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre-Bénite, France
| | - Pierre Morel
- Service d'Hématologie Clinique et de Thérapie Cellulaire, CHU Amiens, Salouel, France
| | - Lila Gilis
- Centre Hospitalier Lyon Sud, Pierre Benite, France
| | | | - Anaïse Blouet
- Service Oncologie-Hématologie, Centre Hospitalier Cholet, Cholet, France
| | - Stéphanie Nguyen Quoc
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Jean Jacques Boffa
- Nephrology Department, Sorbonne Université Hôpital Tenon APHP, Paris, France
| | - Pierre Ronco
- Nephrology Department, Sorbonne Université Hôpital Tenon APHP, Paris, France
| | - Jerome Lambert
- Biostatistics Department, University of Paris, AP-HP, Saint Louis Hospital, Paris, France
| | - Jérôme Cornillon
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint-Etienne, Saint-Etienne, France
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Gaffney KJ, Bakos JK, Velayati A, Davis JA, Thurlapati A, Weeda E, Maldonado A, Granger K, Butcher C, Herrington T, Smith D, Green K, Hess BT, Hashmi H. Impact of age, obesity, and renal impairment on outcomes after autologous stem cell transplantation for patients with newly diagnosed multiple myeloma. J Oncol Pharm Pract 2024:10781552231224361. [PMID: 38166529 DOI: 10.1177/10781552231224361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
INTRODUCTION There remains a need to determine whether certain subgroups of newly diagnosed multiple myeloma (NDMM) derive the same benefit from high-dose chemotherapy-autologous stem cell transplant (HDT-ASCT). We describe our institutional experience highlighting the impact of age, obesity, and renal impairment on outcomes after HDT-ASCT for patients with NDMM in a real-world setting. METHODS A total of 449 consecutive patients were included in this retrospective analysis. RESULTS No difference in median progression free survival or overall survival was seen for patients with age > 65, body mass index (BMI) > 30 kg/m2, or estimated glomerular filtration rate < 60 mL/min/1.73 m2 when compared to those without these characteristics. From a safety standpoint, there were no differences in the incidence of transplant-related mortality or secondary malignancy among subgroups. CONCLUSION For patients with NDMM undergoing HDT-ASCT, there is no difference in outcomes based on age, BMI, or renal function, and the presence of one or more of these factors should not preclude patients from HDT-ASCT.
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Affiliation(s)
- Kelly J Gaffney
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan K Bakos
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Arash Velayati
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - James A Davis
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Aswani Thurlapati
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Weeda
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Andy Maldonado
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Katelynn Granger
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Coleen Butcher
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Taylor Herrington
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Deidra Smith
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly Green
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Brian T Hess
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Hamza Hashmi
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
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Bostankolu Değirmenci B, Yegin ZA, Akdemir ÜÖ, Dede A, Gündem GG, Özkurt ZN, Atay LÖ, Yağcı M. Clinical factors associated with autologous stem cell transplantation outcomes in multiple myeloma: upfront transplant with MEL200 remains the standard of care. Ann Hematol 2024; 103:269-283. [PMID: 37880484 DOI: 10.1007/s00277-023-05511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Autologous stem cell transplantation (ASCT) remains the mainstay of the treatment in newly diagnosed transplant-eligible multiple myeloma (MM) patients. This retrospective study was performed to investigate the potential prognostic markers which may modify transplant course in a total of 256 ASCT recipients [median age: 58 (30-74) years; male/female: 138/118], including pretransplant (PET0) and day + 60 (PET2) PET/CT assessments and comparative analysis of melphalan (Mel) dose. Better responses with significantly higher complete response/very good partial response rates were achieved in patients who proceeded to transplant within 301 days from diagnosis (p < 0.001). Patients who had received < 1.5 lines of treatment prior to transplant had significantly higher probability of overall survival (OS) (p = 0.004) and progression-free survival (PFS) (p < 0.001). The probability of OS was significantly higher in patients with low Eastern Cooperative Oncology Group (ECOG) performance score (PS = 0-1) (p = 0.003) and HCT-Comorbidity Index (HCT-CI = 0) (p = 0.011). The number of involved areas (p = 0.028) and maximum standardized uptake value (SUVmax) (p = 0.021) in PET0 represented significant impact on OS. The probabilities of OS (p < 0.001) and PFS (p = 0.01) were significantly better with Mel200 mg/m2 conditioning compared to Mel140 mg/m2. Conditioning with Mel200 mg/m2, early and upfront ASCT and low pretransplant treatment burden were found to be significantly associated with ASCT outcome in MM patients. Despite its predictor impact on survival and prognosis, further studies are warranted to standardize PET/CT-based response assessments before being used as a guide for treatment decisions in clinical practice.
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Affiliation(s)
| | - Zeynep Arzu Yegin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Ümit Özgür Akdemir
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ali Dede
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gonca Gül Gündem
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Münci Yağcı
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
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Ursu SG, Maples S, Williams KJ, Patrus G, Samhouri Y, Fazal S, Mewawalla P, Sadashiv S. The Impact of Renal Impairment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation With Melphalan Conditioning. J Hematol 2023; 12:201-207. [PMID: 37936977 PMCID: PMC10627361 DOI: 10.14740/jh1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background There are no standard renal dose adjustments for melphalan conditioning for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. The objective of this study was to evaluate the effect of melphalan dosing and chronic kidney disease (CKD) on transplant-related outcomes, progression-free survival (PFS), and overall survival (OS). Methods A retrospective chart review was performed, and MM patients who underwent ASCT between February 2016 and September 2021 were included. Melphalan 200 mg/m2 (Mel200) or 140 mg/m2 (Mel140) was administered. The cohort was divided based on renal function: creatinine clearance (CrCl) ≥ 60 mL/min (no-CKD) and CrCl < 60 mL/min (CKD). Outcomes measured include PFS, OS, treatment-related mortality (TRM), incidence of adverse events, hospitalization duration, and hospital readmission within 30 days. Statistical analysis included Chi-square test, t-test, and Kaplan-Meier method. Logistic regression model was used to account for melphalan dose adjustment. Results A total of 124 patients were included (n = 108 no-CKD, and n = 16 CKD). Median age was 62 years, majority (62%) were male, and 97% had at least a partial response at time of ASCT. Of the 124 patients, nine (7%) received Mel140. Five of these patients had CKD (CrCl range: 26 - 58 mL/min), with one on hemodialysis. Median time to neutrophil engraftment was 13.6 vs. 14.9 days and median time to platelet engraftment was 18.3 vs. 18.5 days in the CKD group vs. no-CKD group, respectively (P = 0.03 and P = 0.8). When adjusting for melphalan dose reduction, the median time to neutrophil engraftment was not statistically significant (P = 0.11). At a median follow-up of 28.7 months, the median PFS for the CKD vs. no-CKD group was 60 vs. 46 months (P = 0.3). One-year OS was 93.8% in the CKD group vs. 97% in the no-CKD group. There was a higher incidence of grade 3 or 4 mucositis in the CKD group vs. no-CKD group (P = 0.013). Conclusions There is no significant difference in engraftment, PFS, or OS for MM patients with CKD vs. no-CKD receiving melphalan conditioning for ASCT. Severe mucositis was significantly more common in the CKD group, including when accounting for melphalan dose reduction.
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Affiliation(s)
- Sorana G. Ursu
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Samantha Maples
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Kiersten J. Williams
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Gina Patrus
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Yazan Samhouri
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Salman Fazal
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Prerna Mewawalla
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Santhosh Sadashiv
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
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Nesr G, Shah R, Kyriakou C, Sive J, Popat R, Yong K, Wisniowski B, Xu K, Wechalekar A, Lee L, Ings S, Papanikolaou X, Mahmood S, Mcmillan A, Horder J, Newrick F, Marfil J, Ainley L, Asher S, Cheesman S, Rabin N. Impact of timing of stem cell return following high dose melphalan in multiple myeloma patients with renal impairment: a single center experience. Leuk Lymphoma 2023; 64:1465-1471. [PMID: 37259553 DOI: 10.1080/10428194.2023.2216817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) remains the standard consolidation in transplant eligible multiple myeloma (MM) patients. The timing between HDM administration and hematopoietic stem cell return (HSCR) varies among institutions, with a 'rest period' of 48 hours (h) employed by some for patients with renal impairment (RI). We investigated the differences in hematopoietic recovery and HDM toxicity between MM patients with RI who had HSCR after 24 vs 48 h from HDM. Fifty MM patients with RI (48 h group; n = 31 and 24 h group; n = 19) were included. No statistically significant differences were noted in surrogates for hematopoietic recovery and HDM toxicity between both groups. Only one death occurred in the 24 h group. No patients required renal replacement therapy. Therefore, a 24 h period between HDM and AHSC infusion appears safe for MM patients with RI.
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Affiliation(s)
- George Nesr
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Raakhee Shah
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Charalampia Kyriakou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jonathan Sive
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rakesh Popat
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kwee Yong
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brendan Wisniowski
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ke Xu
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashu Wechalekar
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lydia Lee
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stuart Ings
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Xenofon Papanikolaou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Shameem Mahmood
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Annabel Mcmillan
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jackie Horder
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Fiona Newrick
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jotham Marfil
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Ainley
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Samir Asher
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Simon Cheesman
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Neil Rabin
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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7
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Ali MO, Al Hadidi S. High dose (conditioning) regimens used prior to autologous stem cell transplantation in multiple myeloma. Transplant Cell Ther 2022; 28:572-580. [DOI: 10.1016/j.jtct.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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8
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Autologous stem cell transplantation for multiple myeloma patients with chronic kidney disease: a safe and effective option. Bone Marrow Transplant 2022; 57:959-965. [PMID: 35413986 PMCID: PMC9200631 DOI: 10.1038/s41409-022-01657-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
Chronic Kidney Disease (CKD) is a frequent complication in patients with multiple myeloma (MM) and is associated with adverse outcomes. The use of autologous stem cell transplantation (ASCT) has improved disease outcomes, however, the safety and efficacy of ASCT in patients with CKD has been the subject of debate. To investigate this, we conducted a retrospective analysis of 370 MM patients who underwent their first ASCT, including those with mild, moderate and severe CKD as well as normal renal function at the time of transplant. No significant difference in ASCT-related mortality, Progression-Free or Overall Survival was noted between the different renal function groups. A decline in estimated glomerular filtration rate (eGFR) at 1-year of >8.79% was associated with poorer overall survival (p < 0.001). The results of this study show that ASCT is a safe and effective option for myeloma patients with CKD, including those on dialysis. Patients who demonstrate renal deterioration at 1-year post-transplant should be closely monitored as this is a predictor for poor survival.
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9
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Duque-Afonso J, Ewald S, Ihorst G, Waterhouse M, Struessmann T, Zeiser R, Wäsch R, Bertz H, Müller-Quernheim J, Duyster J, Finke J, Marks R, Engelhardt M. The impact of pulmonary function in patients undergoing autologous stem cell transplantation. Blood Adv 2021; 5:4327-4337. [PMID: 34610094 PMCID: PMC8579263 DOI: 10.1182/bloodadvances.2021004863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
High-dose chemotherapy, followed by autologous hematopoietic stem cell transplantation (auto-HSCT), is an established therapy for patients with hematological malignancies. The age of patients undergoing auto-HSCT and, therefore, the comorbidities, has increased over the last decades. However, the assessment of organ dysfunction prior to auto-HSCT has not been well studied. Therefore, we retrospectively analyzed the association of clinical factors and lung and cardiac function with outcome and complications after conditioning with BEAM (BCNU/carmustine, etoposide, cytarabine, melphalan) or high-dose melphalan in patients undergoing auto-HSCT. This study included 629 patients treated at our institution between 2007 and 2017; 334 and 295 were conditioned with BEAM or high-dose melphalan, respectively. The median follow-up was 52 months (range, 0.2-152) and 50 months (range, 0.5-149), respectively. In the multivariate analysis, we identified that progressive disease, CO-diffusion capacity corrected for hemoglobin (DLCOcSB) ≤ 60% of predicted, Karnofsky Performance Status (KPS) ≤ 80%, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score ≥ 4, and age > 70 years were associated with decreased overall survival (OS) in patients treated with BEAM. Similarly, DLCOcSB ≤ 60% of predicted, HCT-CI score ≥ 4, and age > 60 years were identified in patients treated with high-dose melphalan. Abnormalities in DLCOcSB ≤ 60% of predicted were associated with chemotherapy with lung-toxic substances, mediastinal radiotherapy, KPS ≤ 80%, current/previous smoking, and treatment in the intensive care unit. More often, patients with DLCOcSB ≤ 60% of predicted experienced nonrelapse mortality, including pulmonary causes of death. In summary, we identified DLCOcSB ≤ 60% of predicted as an independent risk factor for decreased OS in patients conditioned with BEAM or high-dose melphalan prior to auto-HSCT.
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Affiliation(s)
| | - Sophie Ewald
- Department of Hematology/Oncology/Stem Cell Transplantation
| | | | | | | | - Robert Zeiser
- Department of Hematology/Oncology/Stem Cell Transplantation
| | - Ralph Wäsch
- Department of Hematology/Oncology/Stem Cell Transplantation
| | - Hartmut Bertz
- Department of Hematology/Oncology/Stem Cell Transplantation
| | - Joachim Müller-Quernheim
- Department of Pneumology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology/Oncology/Stem Cell Transplantation
| | - Jürgen Finke
- Department of Hematology/Oncology/Stem Cell Transplantation
| | - Reinhard Marks
- Department of Hematology/Oncology/Stem Cell Transplantation
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10
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UNCU ULU B, BAKIRTAŞ M, YİĞENOĞLU TN, BAŞCI S, YILDIZ J, ŞAHİN D, DARÇIN T, MERDİN A, BATGİ H, İSKENDER D, BAYSAL NA, DAL S, KIZIL ÇAKIR M, ALTUNTAŞ F. Efficacy of reduced dose melphalan conditioning for multiple myeloma patients undergoing autologous stem cell transplantation: in the era of combined induction with novel agents. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.868279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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11
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Gastrointestinal toxicity of high-dose melphalan in autologous hematopoietic stem cell transplantation: identification of risk factors and a benchmark for experimental therapies. Ann Hematol 2021; 100:1863-1870. [PMID: 33388856 DOI: 10.1007/s00277-020-04378-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Gastrointestinal side effects are the dose-limiting toxicity of high-dose melphalan (HDM) in autologous hematopoietic stem-cell transplantation, but there are limited contemporary data on the incidence and severity of gastrointestinal toxicity associated with this regimen. We retrospectively studied 100 consecutive patients who received HDM alone or in combination with other conditioning agents. Patients had a median age of 56 (range 20-73); underlying diseases were myeloma (42%), lymphoma (42%), or amyloidosis (16%) and melphalan dosages were 200 (40%), 140 (59%), or 100 mg/m2 (1%). Ninety-seven percent of patients experienced diarrhea with a range of 1-18 bowel movements per day, 88% developed nausea, and 60% experienced vomiting. Abdominal CT scans rarely altered patient management, but stool studies were useful in identifying a treatable infectious source. Grade ≥ 2 diarrhea was associated with longer duration of diarrhea, longer length of stay, worse hypoalbuminemia, higher use of antibiotics, abdominal imaging, electrolyte repletions, and anti-diarrheal agents. Risk factors for severe diarrhea were female sex, melphalan dose, age > 50, creatinine clearance < 60 ml/min, and having a plasma cell neoplasm as opposed to lymphoma. Female sex was also associated with more severe nausea and vomiting. In summary, diarrhea remains an important toxicity of HDM and novel therapies for chemotherapy-induced diarrhea for patients undergoing stem-cell transplantation are needed. Grade 2 or higher diarrhea is associated with significant clinical consequences and should be used as the primary endpoint in prospective clinical trials.
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12
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Sweiss K, Vemu B, Hofmeister CC, Wenzler E, Calip GS, Galvin JP, Mahmud N, Rondelli D, Johnson JJ, Patel P. Development of a method for clinical pharmacokinetic testing to allow for targeted Melphalan dosing in multiple myeloma patients undergoing autologous transplant. Br J Clin Pharmacol 2020; 86:2165-2173. [PMID: 32285957 PMCID: PMC7576633 DOI: 10.1111/bcp.14308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS High dose melphalan (HDM) and autologous stem cell transplant (ASCT) is standard of care for multiple myeloma (MM), but there is significant variability in melphalan exposure (area under the plasma drug concentration-time curve, AUC) when using body surface area-based dosing. Our aim was to establish a method of pharmacokinetic (PK) testing for real-time melphalan dose adjustments. METHODS We performed a prospective PK study of melphalan 140 or 200 mg/m2 in MM patients undergoing ASCT. Twenty MM patients were administered HDM on days -2 and - 1, with PK sampling at 8-10 time points. PK testing was performed on day -2 in all patients, and on day -1 in 5 patients. RESULTS Less than 20% interpatient variation in the day -2 and - 1 AUC was observed. The day -2 range in AUC (4.95-11.28 mg h/L) confirmed significant interpatient variability. The hypothetical total dose ranged from 133-302 mg/m2 to achieve the total median AUC. A 4-time point AUC (0, 30, 150 and 240 min) highly correlated with the AUC from the 8-time point schedule. A higher AUC correlated with increased risk of febrile neutropenia (P = .05). CONCLUSION Here we outline the methods to establish novel melphalan dosing using PK testing in MM patients undergoing ASCT to target a desired melphalan AUC.
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Affiliation(s)
- Karen Sweiss
- Department of Pharmacy PracticeUniversity of Illinois at ChicagoChicagoILUSA
- Cancer CenterUniversity of IllinoisChicagoILUSA
| | - Bhaskar Vemu
- Department of Pharmacy PracticeUniversity of Illinois at ChicagoChicagoILUSA
| | - Craig C. Hofmeister
- Department of Hematology and Medical OncologyWinship Cancer Institute of Emory UniversityAtlantaGAUSA
| | - Eric Wenzler
- Department of Pharmacy PracticeUniversity of Illinois at ChicagoChicagoILUSA
| | - Gregory Sampang Calip
- Cancer CenterUniversity of IllinoisChicagoILUSA
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoILUSA
| | - John P. Galvin
- Cancer CenterUniversity of IllinoisChicagoILUSA
- Division of Hematology/OncologyUniversity of Illinois at ChicagoChicagoILUSA
| | - Nadim Mahmud
- Cancer CenterUniversity of IllinoisChicagoILUSA
- Division of Hematology/OncologyUniversity of Illinois at ChicagoChicagoILUSA
| | - Damiano Rondelli
- Cancer CenterUniversity of IllinoisChicagoILUSA
- Division of Hematology/OncologyUniversity of Illinois at ChicagoChicagoILUSA
| | - Jeremy James Johnson
- Department of Pharmacy PracticeUniversity of Illinois at ChicagoChicagoILUSA
- Cancer CenterUniversity of IllinoisChicagoILUSA
| | - Pritesh Patel
- Cancer CenterUniversity of IllinoisChicagoILUSA
- Division of Hematology/OncologyUniversity of Illinois at ChicagoChicagoILUSA
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13
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Sweiss K, Calip GS, Holden J, Lewkowski P, Mialik I, Johnson J, Galvin JP, Rondelli D, Patel P. Predictors of increased melphalan exposure correlate with overall survival, nonrelapse mortality, and toxicities in patients undergoing reduced-intensity allogeneic stem cell transplantation with fludarabine and melphalan. J Oncol Pharm Pract 2020; 27:579-587. [PMID: 32493164 DOI: 10.1177/1078155220927436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The reduced-intensity conditioning regimen, fludarabine and melphalan 140 mg/m2 (FM140), is widely adopted in practice. Pharmacokinetic studies report 10-fold interpatient variability in melphalan exposure. We identified low hemoglobin (Hb) and/or creatinine clearance (CrCl), determinants of melphalan pharmacokinetic, as strong predictors of outcomes after high-dose melphalan and autologous transplant. We hypothesized that these variables could predict for outcomes after FM140. Overall survival was shorter in patients with a lower Hb (113 vs. 2536 days; p = 0.004), due to an increased rate of nonrelapse mortality (NRM) (p = 0.0005). Overall survival was also worse in patients with lower CrCl (75 vs. 317 days; p = 0.003), with a significantly worse nonrelapse mortality (p = 0.0023). In a multivariate analysis, a higher Hb and CrCl predicted for better overall survival (p = 0.017). In patients with a lower Hb, the median duration of hospitalization (p = 0.02) and the mean duration of diarrhea (p = 0.008) were longer. In patients with a lower CrCl, the median duration of hospitalization (p = 0.06) and the mean duration of diarrhea (p = 0.0009) longer, and the rate of infection was higher (p = 0.02). We show for the first time that Hb and CrCl represent important determinants of outcomes after FM140, suggesting that pharmacokinetic-directed dosing may be beneficial in achieving optimal outcomes.
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Affiliation(s)
- Karen Sweiss
- Department of Pharmacy Practice, College of Pharmacy, 14681University of Illinois at Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois, Chicago, IL, USA
| | - Gregory Sampang Calip
- Cancer Center, University of Illinois, Chicago, IL, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Jaime Holden
- Department of Pharmacy Practice, College of Pharmacy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Paulina Lewkowski
- Department of Pharmacy Practice, College of Pharmacy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Iryna Mialik
- Department of Pharmacy Practice, College of Pharmacy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Jeremy Johnson
- Department of Pharmacy Practice, College of Pharmacy, 14681University of Illinois at Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois, Chicago, IL, USA
| | - John P Galvin
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology/Oncology, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Damiano Rondelli
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology/Oncology, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Pritesh Patel
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology/Oncology, 14681University of Illinois at Chicago, Chicago, IL, USA
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14
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Kumar L, Chellapuram SK, Dev R, Varshneya A, Pawar S, Sharma A, Mookerjee A, Sahoo RK, Malik PS, Sharma A, Gupta R, Sharma O, Biswas A, Kumar R, Thulkar S, Mallick S. Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma. Clin Hematol Int 2019; 1:205-219. [PMID: 34595432 PMCID: PMC8432369 DOI: 10.2991/chi.d.190805.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022] Open
Abstract
We investigated the impact of renal impairment (RI) on the outcome in multiple myeloma (MM) patients following induction and autologous stem cell transplantation (ASCT). Among 349 patients who received a first ASCT for MM, 86 (24.6%) had RI at diagnosis, defined as estimation of glomerular filtration rate (eGFR) <40 mL/min/1.73 m2 according to the modification of diet in renal disease (MDRD) formula. Post induction reversal of renal function occurred in 68 (79%) patients including complete renal response in 37.2%. Two hundred and fifty-one patients had received novel agents for induction; posttransplant complete response (CR) rates were 71.4% for patients with renal impairment (RI) versus 67.2% in those without RI, p = 0.23. The quality of stem cell collection and days to engraftment were similar except that patients with RI required higher transfusion numbers of packed red cells (p < 0.002) and platelets (p < 0.007). The median overall survival (OS) was 96 months (95% confidence interval [CI] 72.80–119.20) for patients with eGFR ≥40 mL/min, n = 195) versus 62 months (95% CI 28.7–95.3) for 56 patients with RI (eGFR <40 mL/min), p = 0.15. The 5-year OS was 64.6% versus 54.4%, respectively. The median progression-free survival (PFS) was 52 months (95% CI 36.3–67.7) for patients with eGFR ≥40 mL/min versus “not reached” for those with eGFR <40 mL/min p = 0.87; and the 5-year PFS was 48.1% versus 51%, respectively. We conclude that induction with novel agents results in reversal of renal dysfunction in the majority of patients. Consolidation with Hemopoietic Stem Cell Transplantation (HSCT) overcomes the adverse impact of RI on survival.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Santosh Kumar Chellapuram
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ramavat Dev
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ankur Varshneya
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Satyajit Pawar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Aparna Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Anjali Mookerjee
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ritu Gupta
- Department of Lab Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Omdutta Sharma
- Department of Lab Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Sauumyaranjan Mallick
- Department of Pathology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
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15
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Sweiss K, Calip GS, Johnson JJ, Rondelli D, Patel PR. Pretransplant hemoglobin and creatinine clearance correlate with treatment-free survival after autologous stem cell transplantation for multiple myeloma. Bone Marrow Transplant 2019; 54:2081-2087. [PMID: 31388085 DOI: 10.1038/s41409-019-0628-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
Melphalan is given at a dose of 200 mg/m2 (Mel200) prior to ASCT for multiple myeloma (MM). Pharmacokinetic (PK) studies show a high degree of interpatient variability. We aimed to test the impact of clinical factors previously shown to affect melphalan PK such as hemoglobin (Hgb), fat-free mass (FFM), and creatinine clearance (CrCl) on outcomes. Median Hgb (from day -2 to -1) and FFM were grouped as low or high relative to their sample medians, and CrCl was divided into ≥60 or <60 ml/min. In 133 MM patients, median TFS (defined as time from ASCT to initiation of next subsequent line of therapy or death) was longer in patients with lower Hgb (35 vs. 16 months, p = 0.02). Patients with both lower Hgb and CrCl experienced longer TFS compared to those with higher Hgb and CrCl (35 vs. 13 months, p = 0.03). In multivariate analysis, lower hemoglobin, lower CrCl, and a combined low hemoglobin and CrCl were strongly associated with improved TFS. Patients with a lower hemoglobin or creatinine clearance experienced significantly more toxicity. We show for the first time that Hgb and CrCl are important predictors of outcomes after Mel200. PK-directed melphalan dosing may be beneficial in achieving optimal outcomes.
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Affiliation(s)
- Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA. .,Cancer Center, University of Illinois, Chicago, IL, USA.
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeremy J Johnson
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois, Chicago, IL, USA
| | - Damiano Rondelli
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
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16
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Gonsalves WI, Buadi FK, Ailawadhi S, Bergsagel PL, Chanan Khan AA, Dingli D, Dispenzieri A, Fonseca R, Hayman SR, Kapoor P, Kourelis TV, Lacy MQ, Larsen JT, Muchtar E, Reeder CB, Sher T, Stewart AK, Warsame R, Go RS, Kyle RA, Leung N, Lin Y, Lust JA, Russell SJ, Zeldenrust SR, Fonder AL, Hwa YL, Hobbs MA, Mayo AA, Hogan WJ, Rajkumar SV, Kumar SK, Gertz MA, Roy V. Utilization of hematopoietic stem cell transplantation for the treatment of multiple myeloma: a Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus statement. Bone Marrow Transplant 2019; 54:353-367. [PMID: 29988062 PMCID: PMC6463224 DOI: 10.1038/s41409-018-0264-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 12/22/2022]
Abstract
Over the last two decades, the utilization of various novel therapies in the upfront or salvage settings has continued to improve survival outcomes for patients with Multiple Myeloma (MM). Thus, the conventional role for hematopoietic stem cell transplantation (HSCT) in MM either in the form of an autologous stem cell transplant (ASCT) or an allogeneic stem cell transplant (Allo-SCT) warrants re-evaluation, given the aforementioned clinical advances. Here, we present a consensus statement of our multidisciplinary group of over 30 Mayo Clinic physicians with a special interest in the care of patients with MM and provide evidence-based recommendations on the use of HSCT in MM. We specifically address topics that include the role and timing of an ASCT for MM in the era of novel agents, eligibility for an ASCT, post-ASCT consolidation, and maintenance options, and finally the utility of an upfront tandem ASCT, salvage second ASCT, and an allo-SCT in MM.
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Affiliation(s)
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - P Leif Bergsagel
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Asher A Chanan Khan
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Susan R Hayman
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy T Larsen
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Taimur Sher
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - A Keith Stewart
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Amie L Fonder
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Miriam A Hobbs
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela A Mayo
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
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17
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Tamaki M, Nakasone H, Gomyo A, Hayakawa J, Akahoshi Y, Harada N, Kusuda M, Ishihara Y, Kawamura K, Tanihara A, Sato M, Terasako-Saito K, Kameda K, Wada H, Kikuchi M, Kimura SI, Kako S, Kanda Y. Lower glomerular filtration rate predicts increased hepatic and mucosal toxicity in myeloma patients treated with high-dose melphalan. Int J Hematol 2018; 108:423-431. [PMID: 30039440 DOI: 10.1007/s12185-018-2507-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 12/22/2022]
Abstract
High-dose melphalan followed by autologous hematopoietic stem cell transplantation (ASCT) is a standard treatment for younger myeloma patients. However, the correlation between its toxicity and renal impairment is not clear. We analyzed this relationship, focusing on estimated glomerular filtration rate (eGFR) as an index of renal function. We evaluated 78 multiple myeloma patients who underwent ASCT following high-dose melphalan at our center. Patients were divided into a higher eGFR group (eGFR ≥ 60) and a lower eGFR group (eGFR < 60). Multivariate analyses revealed that lower eGFR was independently associated with alkaline phosphatase elevation (OR 10.2, P = 0.038), mucositis (OR 10.5, P = 0.032), grade 2-4 co-elevation of both aspartate aminotransferase and alanine aminotransferase (OR 21.3, P = 0.016), delay of reticulocyte engraftment (HR 0.524, P = 0.034), and delay of platelet engraftment (HR 0.535, P = 0.0016). However, lower eGFR was not correlated with overall survival or time-to-next treatment. In summary, renal dysfunction secondary to administration of high-dose melphalan was associated with increased hepatic and mucosal toxicity and delay of hematological recovery, but did not affect survival outcomes.
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Affiliation(s)
- Masaharu Tamaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Ayumi Gomyo
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Jin Hayakawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Naonori Harada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Machiko Kusuda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Aki Tanihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama, 330-8503, Japan.
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18
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Tay J, Daly A, Jamani K, Labelle L, Savoie L, Stewart D, Storek J, Beattie S. Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables. Bone Marrow Transplant 2018; 54:368-382. [PMID: 29988063 DOI: 10.1038/s41409-018-0265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.
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Affiliation(s)
- J Tay
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
| | - A Daly
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - K Jamani
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Labelle
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Savoie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - D Stewart
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - J Storek
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - S Beattie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
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Waszczuk-Gajda A, Lewandowski Z, Drozd-Sokołowska J, Boguradzki P, Dybko J, Wróbel T, Basak GW, Jurczyszyn A, Mądry K, Snarski E, Frączak E, Charliński G, Feliksbrot-Bratosiewicz M, Król M, Matuszkiewicz-Rowińska J, Klinger M, Krajewska M, Augustyniak-Bartosik H, Kościelska M, Rusicka P, Dwilewicz-Trojaczek J, Wiktor Jędrzejczak W. Autologous peripheral blood stem cell transplantation in dialysis-dependent multiple myeloma patients-DAUTOS Study of the Polish Myeloma Study Group. Eur J Haematol 2018; 101:475-485. [DOI: 10.1111/ejh.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics; Warsaw Medical University; Warsaw Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Piotr Boguradzki
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Jarosław Dybko
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Tomasz Wróbel
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Władysław Basak
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Artur Jurczyszyn
- Department of Haematology; Jagiellonian University; Kraków Poland
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Emilian Snarski
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Ewa Frączak
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Charliński
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
- Department of Haematology; Nicolaus Copernicus Specialist Municipal Hospital; Toruń Poland
| | | | - Małgorzata Król
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | | | - Małgorzata Kościelska
- Department of Nephrology and Internal Diseases; Medical University of Warsaw; Warsaw Poland
| | - Patrycja Rusicka
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
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Augeul-Meunier K, Chretien ML, Stoppa AM, Karlin L, Benboubker L, Diaz JMT, Mohty M, Yakoub-Agha I, Bay JO, Perrot A, Bulabois CE, Huynh A, Mercier M, Frenzel L, Avet-Loiseau H, de Latour RP, Cornillon J. Extending autologous transplantation as first line therapy in multiple myeloma patients with severe renal impairment: a retrospective study by the SFGM-TC. Bone Marrow Transplant 2018. [DOI: 10.1038/s41409-018-0122-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Auner HW, Iacobelli S, Sbianchi G, Knol-Bout C, Blaise D, Russell NH, Apperley JF, Pohlreich D, Browne PV, Kobbe G, Isaksson C, Lenhoff S, Scheid C, Touzeau C, Jantunen E, Anagnostopoulos A, Yakoub-Agha I, Tanase A, Schaap N, Wiktor-Jedrzejczak W, Krejci M, Schönland SO, Morris C, Garderet L, Kröger N. Melphalan 140 mg/m 2 or 200 mg/m 2 for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica 2017; 103:514-521. [PMID: 29217776 PMCID: PMC5830386 DOI: 10.3324/haematol.2017.181339] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/01/2017] [Indexed: 12/22/2022] Open
Abstract
Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m2 is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m2 and melphalan 140 mg/m2 are equally effective and tolerable in clinically relevant patient subgroups we analyzed 1964 first single autologous transplantation episodes using a series of Cox proportional-hazards models. Overall survival, progression-free survival, cumulative incidence of relapse, non-relapse mortality, hematopoietic recovery and second primary malignancy rates were not significantly different between the melphalan 140 mg/m2 (n=245) and melphalan 200 mg/m2 (n=1719) groups. Multivariable subgroup analysis showed that disease status at transplantation interacted with overall survival, progression-free survival, and cumulative incidence of relapse, with a significant advantage associated with melphalan 200 mg/m2 in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m2versus melphalan 140 mg/m2: 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m2 for overall survival (adjusted hazard ratio: 2.02). Age, renal function, prior proteasome inhibitor treatment, gender, or Karnofsky score did not interact with overall/progression-free survival or relapse rate in the melphalan dose groups. There were no significant survival or relapse rate differences between melphalan 200 mg/m2 and melphalan 140 mg/m2 patients with high-risk or standard-risk chromosomal abnormalities. In conclusion, remission status at the time of transplantation may favor the use of melphalan 200 mg/m2 or melphalan 140 mg/m2 for key transplant outcomes (NCT01362972).
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Affiliation(s)
| | | | - Giulia Sbianchi
- Department of Biology, Tor Vergata University of Rome, Italy
| | | | | | | | | | | | - Paul V Browne
- St. James's Hospital, Trinity College Dublin, Ireland
| | - Guido Kobbe
- Heinrich Heine Universität, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | | - Nicolaas Schaap
- Radboud University Medical Centre, Nijmegen, the Netherlands
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Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis. Bone Marrow Transplant 2017; 52:1616-1622. [PMID: 28920949 PMCID: PMC5859934 DOI: 10.1038/bmt.2017.198] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008-2013 were identified (N =1492) and grouped as normal/mild (≥60 ml/min), N=1240, moderate (30-59), N=185 and severe RI (<30), N=67 based on MDRD. Multivariate analysis of non-relapse mortality (NRM), relapse, progression-free survival (PFS) and overall survival (OS) was performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m2 (Mel200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m2 (Mel140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31-38)%, 40 (31-49)% and 27 (15-40)% respectively, (p=0·42); 5-year OS for normal, mod and severe RI was 68 (65-71)%, 68 (60-76)% and 60 (46-74)% respectively, (p=0·69). With moderate RI, 5-year PFS for HDM 140 mg/m2 was 18 (6-35)% and for Mel200 was 46 (36-57)% (p=0·009). With severe RI, 5-year PFS Mel140 was 25 (11-41) % and for Mel200 was 32 (11-58)% (p=0·37). We conclude that AHCT is safe and effective in patients with MM with RI.
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Esma F, Salvini M, Troia R, Boccadoro M, Larocca A, Pautasso C. Melphalan hydrochloride for the treatment of multiple myeloma. Expert Opin Pharmacother 2017; 18:1127-1136. [DOI: 10.1080/14656566.2017.1349102] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fabrizio Esma
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rossella Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Pautasso
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Could renal impairment be a positive predictor of outcome in autografts for myeloma? Bone Marrow Transplant 2016; 51:1305-1306. [PMID: 27183097 DOI: 10.1038/bmt.2016.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022]
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