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Thurlapati A, Wesson W, Davis JA, Gaffney KJ, Weeda E, Velayati A, Bakos JK, Granger K, Smith D, Maldonado AP, Herrington T, Potts J, Hashmi H. Impact of Cytogenetic Abnormalities, Induction and Maintenance Regimens on Outcomes After High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Newly Diagnosed Multiple Myeloma: A Decade-Long Real-World Experience. J Hematol 2023; 12:243-254. [PMID: 38188477 PMCID: PMC10769645 DOI: 10.14740/jh1201] [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: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
Background High-dose chemotherapy and autologous stem cell transplant (HDT-ASCT) has become a standard of care for transplant eligible newly diagnosed multiple myeloma (NDMM) patients. While cytogenetic abnormalities have been shown to affect outcomes after HDT-ASCT in clinical trials, these trials often exclude or underrepresent elderly patients with comorbidities and those belonging to ethnic minorities. We describe our institutional experience highlighting the impact of high-risk cytogenetic abnormalities (HRCAs) on outcomes after HDT-ASCT for NDMM patients. Methods A total of 449 patients with NDMM who underwent HDT-ASCT between February 2012 and August 2022 were included in this retrospective analysis. HRCAs included the presence of one or more of: deletion 17p, t(14;16), t(4;14), and amplification 1q. Survival analyses, including progression-free survival (PFS) and overall survival (OS), were performed using Kaplan-Meier estimator. Results With a median follow-up of 29 (1 - 128) months for the entire patient population, the best overall response rate for the patients with HRCAs was lower compared to those with standard risk cytogenetics (90% vs. 96%; P = 0.01). Patients with HRCAs had an inferior PFS compared to patients with standard-risk cytogenetics (29 vs. 58 months; P < 0.001) without a difference in OS (70 months vs. not reached; P = 0.13). Conclusions In a multivariable analysis adjusting for factors including age, race, and comorbidities, HRCAs, non-lenalidomide-based maintenance, non-proteasome inhibitor-based maintenance, and age greater than 65 were associated with inferior PFS. Amongst these factors, only non-lenalidomide-based maintenance was associated with inferior OS.
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Affiliation(s)
- Aswani Thurlapati
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
- These authors contributed equally to the creation of the manuscript
| | - William Wesson
- University of Kansas School of Medicine, Kansas City, KS 66103, USA
- These authors contributed equally to the creation of the manuscript
| | - James A. Davis
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Kelly J. Gaffney
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Erin Weeda
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Arash Velayati
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Jonathan K. Bakos
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Katelynn Granger
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Deidra Smith
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Andy P. Maldonado
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Taylor Herrington
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Julia Potts
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Hamza Hashmi
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
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Waidyaratne G, Bennett C, Umyarova E, Bumma N. Extensive Intracardiac Cement Embolism in a Patient Undergoing Workup for Bone Marrow Transplant. J Hematol 2023; 12:283-286. [PMID: 38188473 PMCID: PMC10769642 DOI: 10.14740/jh1202] [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: 10/05/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
Cement emboli are a well-established complication of kyphoplasties and vertebroplasties and can easily be mistaken for wires. While kyphoplasties are commonly performed for vertebral fractures caused by metastases from malignancies such as multiple myeloma, the implication of cement emboli in bone marrow transplant (BMT) patients is not well documented. Our patient presented with an incidental intracardiac cement embolism found while undergoing workup for BMT. He was managed conservatively, but transplant workup was put on hold until the embolism could be removed due to the risks associated with cement emboli. The significance of cement emboli in immunocompromised patients needs to be further investigated.
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Affiliation(s)
- Gavisha Waidyaratne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Caitlin Bennett
- Department of Hospice and Palliative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Elvira Umyarova
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Naresh Bumma
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Schmiady MO, Possner M, Horisberger T, Ouda A. Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6976701. [PMID: 36802249 PMCID: PMC9931077 DOI: 10.1093/icvts/ivac292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Abstract
Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery.
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Affiliation(s)
- Martin O Schmiady
- Corresponding author. Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. Tel: +41-44-255-95-82; fax: +41-44-255-44-67; e-mail: (M.O. Schmiady)
| | - Mathias Possner
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Ouda
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Trongtorsak A, Saad E, Mustafa A, Won KS, Haery C, Hamblin MH, Akbar MS. Incidental detection of an intracardiac cement embolism complicating percutaneous vertebroplasty during cardiac catheterization: A case report. J Cardiol Cases 2022; 26:151-153. [DOI: 10.1016/j.jccase.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
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