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Raza FM, Mkwizu EW, Leak SA, Sadiq AM, Lyamuya FS, Chamba NG, Kilonzo KG, Shao ER, Ahmed EA, Ndale EK, Costantine AR, Kamabu EM, Eliah DT, Nziku EB, Henke O. Factors Associated With Survival Among Patients With Multiple Myeloma in Northeastern Tanzania. JCO Glob Oncol 2024; 10:e2400033. [PMID: 39116359 DOI: 10.1200/go.24.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE This study sought to delineate the clinical, laboratory, and imaging characteristics during multiple myeloma (MM) diagnosis, outline the treatment modalities administered, and ascertain the survival rates among patients with MM over a comprehensive 5-year span in Tanzania. METHODS This retrospective cohort study investigated patients diagnosed with MM at the Cancer Care Clinic, Kilimanjaro Christian Medical Centre, between January 2017 and June 2022. Demographic data, clinical profiles, and survival outcomes were collected. The study employed the Kaplan-Meier method to determine overall survival (OS) and survival rates, supported by univariate analysis and a multivariate Cox regression model with significance of P < .05. RESULTS In this study of 76 patients with MM, bone pain was the most common complaint (76.3%), and patients were age typically older than 50 years (82.5%). Laboratory tests showed frequent abnormalities, such as anemia (51.3%) and hypercalcemia (23.9%). Most patients were at stage III according to Durie Salmon Staging (82.7%), with imaging revealing various bone abnormalities. The median OS was 18.0 months, with 46.1% of patients passing away during the study period. Factors linked to shorter survival included anemia, renal failure, and bone involvement. Infection was the primary cause of death among these patients. The presenting complaint of bone pain significantly affected survival outcomes. CONCLUSION This study provides a comprehensive understanding of MM within the Sub-Saharan African context, highlighting age-related disparities in diagnosis, predominant presenting symptoms like bone pain, factors contributing to delayed diagnoses, and the impact on survival rates. The findings underscore the critical need for early recognition, improved diagnostics, and tailored interventions to enhance outcomes for patients with MM in this region.
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Affiliation(s)
- Faryal M Raza
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elifuraha W Mkwizu
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Steven A Leak
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- School of Cancer Sciences, University of Glasgow, Bearsden, Scotland
| | - Abid M Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Furaha S Lyamuya
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nyasatu G Chamba
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kajiru G Kilonzo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elichilia R Shao
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Eijaaz A Ahmed
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Eliasa K Ndale
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Andrew R Costantine
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Eugenie M Kamabu
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Doreen T Eliah
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Eliada B Nziku
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Section Global Health, University Hospital Bonn, Bonn, Germany
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Kadkhoda D, Nikoonezhad M, Bonakchi H, Mehdizadeh M, Hajifathali A, Baghestani AR, Jabarinanva L, Khadem Maboudi AA. Investigating the effect of pre-transplant thrombocytopenia and anemia on the engraftment and long-term survival in multiple myeloma patients. Transpl Immunol 2024; 82:101991. [PMID: 38199269 DOI: 10.1016/j.trim.2024.101991] [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: 05/14/2023] [Revised: 12/29/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) following high-dose melphalan is the standard treatment for Multiple Myeloma (MM). Despite new treatments, further investigation is needed to identify prognostic factors of ASCT. This study evaluated the impact of thrombocytopenia and anemia on the engraftment of MM patients after ASCT. MATERIALS AND METHODS This retrospective study involved 123 MM patients who underwent ASCT with high-dose Melphalan. Successful engraftment is achieved when both platelets (Plt) and white blood cells (WBC) engraft successfully. We examined the statistically significant cut-offs for the prognostic factors on the admission day. Ultimately, the association of risk factors with the Plt and WBC engraftment and long-term survival were analyzed as the outcomes of interest. RESULTS Spearman's correlation coefficient between Plt and WBC engraftment was 0.396 (p < 0.001). The engraftment in the patients with Plt < 140,000/μL was 17.4% slower (p = 0.036) and the odds of long-term survival was 72% lower (p = 0.016) than in patients with higher Plt. Patients with Hb < 11 g/dL were 12.7% slower in engraftment. Age over 47 was a significant factor in slower engraftment (p = 0.036) which decelerated the engraftment by 15.2%. CONCLUSION Thrombocytopenia and anemia before transplantation are related to slower Plt/WBC engraftment and as prognostic factors might predict the long-term survival of MM patients following ASCT.
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Affiliation(s)
- Dariush Kadkhoda
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nikoonezhad
- Department of Immunology, School of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Hossein Bonakchi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Mehdizadeh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Baghestani
- Physiotherapy Research Center, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Jabarinanva
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Khadem Maboudi
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Nair V, Yanamandra U, Nazneen P. Hematopoietic cell transplantation landscape in India. Med J Armed Forces India 2023; 79:621-630. [PMID: 37981919 PMCID: PMC10654369 DOI: 10.1016/j.mjafi.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 11/21/2023] Open
Abstract
Hematopoietic cell transplantation (HCT), commonly known as Bone marrow transplantation (BMT), is a medical procedure used to treat various conditions, including blood cancers, genetic disorders, and certain autoimmune diseases. The procedure involves replacing damaged or diseased bone marrow with healthy stem cells to promote the production of new, healthy blood cells. In India, HCT has been performed for several years in specialized medical centers. India has a growing healthcare infrastructure, and many hospitals are equipped to perform these procedures. Though there are studies on HCTs done at individual transplant centers in India, a comprehensive analysis of the current landscape of HCT in the country is lacking. HCT in India has seen major advances both in the quantity and quality of HCT centers. This review article has attempted to cover the gaps of HCT in India, including its status in the Armed Forces HCT centers.
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Affiliation(s)
- Velu Nair
- Chief Consultant & Head (Hematology & BMT), Apollo Cancer Center, Gandhinagar, Gujarat, India
- Former Dean, Armed Forces Medical College, Pune & DGMS (Army), Delhi Cantt, India
| | - Uday Yanamandra
- Professor, Department of Hematology & Stem Cell Transplant, Armed Forces Medical College, Pune, India
| | - P.S. Nazneen
- Assistant Divisional Medical Officer & Chief Physician, Divisional Railway Hospital, Ponmalai, Trichy, India
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Yan Y, Liu C, Tian Y, Gao W, Geng C, Dong J, Liu X. The effects of nutritional support on cellular immunity of the patient with multiple myeloma undergoing chemotherapy. Panminerva Med 2023; 65:263-264. [PMID: 31971356 DOI: 10.23736/s0031-0808.19.03785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Yan Yan
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chao Liu
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen Gao
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chuanying Geng
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Dong
- Department of Hematological, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Liu
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China -
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Shin J, Kim MJ, Quan X, Kim JW, Lee S, Park S, Jeong JY, Yea K. Thrombopoietin receptor agonist antibody for treating chemotherapy-induced thrombocytopenia. BMC Cancer 2023; 23:490. [PMID: 37259024 DOI: 10.1186/s12885-023-10975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Thrombocytopenia is a common complication in cancer patients undergoing chemotherapy. Chemotherapy-induced thrombocytopenia (CIT) leads to dose reduction and treatment delays, lowering chemotherapy efficacy and survival rate. Thus, rapid recovery and continuous maintenance of platelet count during chemotherapy cycles are crucial in patients with CIT. Thrombopoietin (TPO) and its receptor, myeloid proliferative leukemia (MPL) protein, play a major role in platelet production. Although several MPL agonists have been developed to regulate thrombopoiesis, none have been approved for the management of CIT due to concerns regarding efficacy or safety. Therefore, the development of effective MPL agonists for treating CIT needs to be further expanded. METHODS Anti-MPL antibodies were selected from the human combinatorial antibody phage libraries using phage display. We identified 2R13 as the most active clone among the binding antibodies via cell proliferation assay using BaF3/MPL cells. The effect of 2R13 on megakaryocyte differentiation was evaluated in peripheral blood CD34+ cells by analyzing megakaryocyte-specific differentiation markers (CD41a+ and CD42b+) and DNA ploidy using flow cytometry. The 2R13-induced platelet production was examined in 8- to 10-week-old wild-type BALB/c female mice and a thrombocytopenia mouse model established by intraperitoneal injection of 5-fluorouracil (150 mg/kg). The platelet counts were monitored twice a week over 14 days post-initiation of treatment with a single injection of 2R13, or recombinant human TPO (rhTPO) for seven consecutive days. RESULTS We found that 2R13 specifically interacted with MPL and activated its signaling pathways. 2R13 stimulated megakaryocyte differentiation, evidenced by increasing the proportion of high-ploidy (≥ 8N) megakaryocytes in peripheral blood-CD34+ cells. The platelet count was increased by a single injection of 2R13 for up to 14 days. Injection of 5-fluorouracil considerably reduced the platelet count by day 4, which was recovered by 2R13. The platelets produced by 2R13 sustained a higher count than that achieved using seven consecutive injections of rhTPO. CONCLUSIONS Our findings suggest that 2R13 is a promising therapeutic agent for CIT treatment.
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Affiliation(s)
- Jiwon Shin
- Department of New Biology, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
| | - Min-Jung Kim
- Department of Biochemistry, Kosin University College of Medicine, Busan, 49267, Republic of Korea
| | - Xingguo Quan
- Department of Microbiology and Immunology, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Ji Woong Kim
- Department of Biochemistry, Kookmin University, Seoul, 02707, Republic of Korea
| | - Sukmook Lee
- Department of Biochemistry, Kookmin University, Seoul, 02707, Republic of Korea
| | - SaeGwang Park
- Department of Microbiology and Immunology, Inje University College of Medicine, Busan, 47392, Republic of Korea.
| | - Jee-Yeong Jeong
- Department of Biochemistry, Kosin University College of Medicine, Busan, 49267, Republic of Korea.
| | - Kyungmoo Yea
- Department of New Biology, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea.
- New Biology Research Center, DGIST, Daegu, 43024, Republic of Korea.
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Geng C, Yang G, Zhou H, Wang H, Li Y, Leng Y, Zhang Z, Jian Y, Chen W. Characteristics and Risk Factors of Ultra-High-Risk Patients with Newly Diagnosed Multiple Myeloma. J Pers Med 2023; 13:jpm13040666. [PMID: 37109052 PMCID: PMC10146518 DOI: 10.3390/jpm13040666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and risk factors of ultra-high-risk (UHR) patients with newly diagnosed multiple myeloma (MM). METHODS We screened UHR patients with a survival of less than 24 months and we selected patients with a concurrent survival of more than 24 months as a control group. We retrospectively analyzed the clinical characteristics of UHR patients with newly diagnosed MM and screened related risk factors. RESULTS In total we analyzed 477 patients, which included 121 (25.4%) UHR patients and 356 (74.6%) control patients. Median overall survival (OS) and progression-free survival (PFS) of UHR patients was 10.5 months (7.5-13.5 months) and 6.3 months (5.4-7.2 months), respectively. Univariate logistic regression analysis showed that age > 65 years, hemoglobin (HGB) < 100 g/L, lactate dehydrogenase (LDH) > 250 U/L, serum creatinine (SCr) > 2 mg/dL, corrected serum calcium (CsCa) > 2.75 mmol/L, B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) > 2 upper limit of normal (ULN), high-risk cytogenetics, Barthel index score, and International Staging System (ISS) stage III were associated with UHR MM. In a multivariate analysis, age > 65 years, LDH > 250 U/L, CsCa > 2.75 mmol/L, BNP or NT-proBNP > 2 ULN, high-risk cytogenetics, and Barthel index score were independent risk factors for UHR MM. Moreover, UHR patients had a worse response rate than control patients. CONCLUSION Our study highlighted the characteristics of UHR MM patients and suggested that the combination of organ insufficiency and highly malignant myeloma cells resulted in poor outcomes of patients with UHR MM.
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Affiliation(s)
- Chuanying Geng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Guangzhong Yang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Huixing Zhou
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Huijuan Wang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yanchen Li
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yun Leng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhiyao Zhang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yuan Jian
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Sood N, Tiwari AK, Pabbi S, Dikshit R, Singh P, Ramaswami A, Gautam D, Singh MK. Clinical Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients: A 5-year Experience from a Single Centre in North India. South Asian J Cancer 2023; 12:185-189. [PMID: 37969670 PMCID: PMC10635772 DOI: 10.1055/s-0042-1748184] [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: 10/15/2022] Open
Abstract
Swati PabbiIntroduction Multiple myeloma (MM) forms a significant proportion of hematological malignancies. Autologous transplantation continues to be an effective consolidation strategy in resource-restricted settings such as India. Objectives The main objective of the study was to analyze the clinical outcomes of autologous hematopoietic stem cell transplant (HSCT) in MM patients in a single tertiary care center in north India over a period of 5 years. Materials and Methods This retrospective observational study was conducted in a tertiary care center in north India. Data of all MM patients who underwent HSCT between January 2014, and December 2018, were analyzed. The outcome of HSCT was investigated in terms of transplant-related mortality (TRM), progression-free survival (PFS), overall survival (OS), and relapse. PFS and OS were calculated by Kaplan-Meier method and differences between the groups were tested for statistical significance using the two-tailed log-rank test. Life-table method was used for the estimation of survival rate at 1, 3, 5, and 6 years. Results Patient characteristics and survival post-transplant was similar to other published Indian studies. In total, 378 patients were diagnosed with MM in our hospital between 2014 and 2018. One hundred ninety-three patients were found to be eligible for autologous HSCT, out of which 52 ended up having a transplant giving us a high percentage (26.9%) of patients receiving a transplant in our setting. Transplant-related mortality (TRM) was nil in the present study. The mean PFS and OS were 62.8 and 70.1 months, respectively. The mean PFS and OS rates at 5 years were 75.3% and 84.2%, respectively. The average cost estimate of HSCT in our setting was 7.2 lakh Indian national rupees. Conclusion Autologous HSCT is a safe procedure with nil 100-day mortality in present series. Moreover, considering the cost of novel agents, autologous transplant remains a cost-effective way for prolonging remission and time-to-next treatment in India.
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Affiliation(s)
- Nitin Sood
- Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Aseem Kumar Tiwari
- Department of Transfusion Medicine and Immunohematology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Swati Pabbi
- Department of Transfusion Medicine and Immunohematology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Roshan Dikshit
- Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Prerna Singh
- Department of Hematology and Stem Cell Transplant, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Amrita Ramaswami
- Department of Hemato-Oncology and BMT, Artemis Hospital, Gurgaon, Haryana, India
| | - Dheeraj Gautam
- Department of Histopathology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Manish Kumar Singh
- Department of Bio-Statistician, Medanta-The Medicity, Gurgaon, Haryana, India
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Banday SZ, Guru F, Ayub M, Ahmed SN, Banday AZ, Mir MH, Nisar R, Hussain S, Bhat GM, Aziz SA. Long-Term Outcomes of Autologous Hematopoietic Stem Cell Transplant (HSCT) for Multiple Myeloma: While New Horizons Emerge, It Is Still Only a Silver Lining for Resource-Constrained Settings. Cureus 2023; 15:e36642. [PMID: 37155458 PMCID: PMC10122934 DOI: 10.7759/cureus.36642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/10/2023] Open
Abstract
Background Significant hurdles impede the optimal implementation of hematopoietic stem cell transplantation (HSCT) in low-middle income countries (LMICs). Herein, we highlight the challenges faced in LMICs while performing HSCT and report the long-term outcomes of patients with newly diagnosed multiple myeloma (MM) who underwent autologous HSCT (AHSCT) at our center. Besides, we provide a comprehensive review of studies reporting long-term outcomes of AHSCT in MM from the Indian subcontinent. Methodology This study was conducted at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Case records of all patients with MM who received AHSCT from December 2010 to July 2018 were reviewed retrospectively. A non-systematic literature search was performed using PubMed and Google Scholar databases. Data regarding clinicopathological parameters and long-term follow-up were extracted from relevant studies and for patients included in our study. Results At our center, 47 patients (median age 52.0 years) with MM underwent AHSCT. Majority of patients had stage III disease (ISS) and median time to transplant was 11.5 months. The five-year progression free survival (PFS) and overall survival (OS) were 59.1% and 81.2%, respectively. Studies from the Indian subcontinent have observed a five-year OS of ~50% to ~85%. However, a greater variability in the five-year PFS has been reported, ranging from ~20% to ~75%. The median time to transplant has ranged from seven to 17 months (indicating time delays) with median CD34 cell counts of 2.7-6.3×106 cells/kg (lower than developed countries). Conclusions Despite significant resource limitations in LMICs, AHSCT is increasingly been performed in MM with encouraging long-term outcomes.
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Affiliation(s)
- Saquib Z Banday
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Faisal Guru
- Department of Medical Oncology, Pediatrics Unit, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Maniza Ayub
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Syed N Ahmed
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aaqib Z Banday
- Department of Pediatrics, Government Medical College, Srinagar, IND
| | - Mohmad H Mir
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Rahila Nisar
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Saleem Hussain
- Department of Laboratory Hematology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Gull M Bhat
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sheikh A Aziz
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Kumar L, Sahoo RK, Kumar S, Baa AK, Tansir G, Pathak N, Malik PS, Sharma OD, Mathew A, Jha A, Gupta R, Sharma A, Biswas A, Kumar R, Thulkar S, Malik S, Dutt A. Autologous stem cell transplant for multiple myeloma: Impact of melphalan dose on the transplant outcome. Leuk Lymphoma 2023; 64:378-387. [PMID: 36416679 DOI: 10.1080/10428194.2022.2148214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We evaluated impact of melphalan dose on transplant outcomes for multiple myeloma. Between 1995 and 2019 459 consecutive patients received a transplant; 69(15%) received melphalan ≤150 mg/m2 (Mel 150 cohort) and 390 (85%) melphalan 200 mg/m2 (MEL 200 cohort). The primary outcome was overall survival (OS) from the date of transplant. Progression-free survival (PFS), engraftment, transplant response, and cumulative relapse at 2 years were secondary outcome measures. Patients in Mel 150 cohort had adverse clinical and laboratory parameters at base line. Transplant response was better for Mel 200 cohort (p < 0.024). Median OS at a median follow-up of 88 months was similar in the two cohorts; 100 Vs 102 months (Mel 200), p = 0.817. Median PFS (60.0 Vs 53 months, p = 0.746), relapse at two years (32.4% Vs 30.9%, p = 0.745) and grade 3-4 mucositis (p = 0.823) were similar. Initial treatment prepares patients better for subsequent similar transplant outcomes despite differences in baseline characteristics.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Annie K Baa
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ghazal Tansir
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pathak
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Om Dutt Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Jha
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Soumyaranjan Malik
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Dutt
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Amer R, Salameh H, Mosleh S, Abu-Taha A, Hamayel H, Enaya A, Adas A, Khursani A, Wild-Ali M, Mousa T, Battat M, Daifallah A, Koni A, Shawahna R. Epidemiology of early infections and predictors of mortality after autologous hematopoietic stem-cell transplantation among multiple myeloma, Hodgkin, and non-Hodgkin lymphoma: the first experience from Palestine. BMC Infect Dis 2022; 22:725. [PMID: 36071381 PMCID: PMC9449926 DOI: 10.1186/s12879-022-07709-4] [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: 04/15/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background Autologous hematopoietic stem-cell transplantation (HSCT) is the standard of care in many relapsed and refractory lymphoid malignancy, neuroblastoma, and multiple myeloma (MM). This study was conducted to describe the epidemiology of early infections that occurred within the first 100 days among patients who received HSCT for MM, Hodgkin (HL), and non-Hodgkin lymphoma (NHL) in Palestine. Methods This study was conducted in a retrospective cohort design in the only autologous HSCT in Palestine in the period between 2014 and 2021. The medical records of the patients were reviewed to identify and collect demographic, clinical, and microbiological data on bacterial, viral, fungal, and parasitic infections as diagnosed by cultures, polymerase chain reaction, and fluorescent antibody testing. Results A total of 145 patients were included in this study (median age = 44.0 [28.0, 53.5] years). Of those, 8 (5.5%) were younger than 18 years, 69 (47.6%) had MM, 53 (36.6%) had HL, and 23 (15.9%) had NHL. The source of fever had no focus in the majority of the cases 82 (56.6%), 12 (8.3%) had bloodstream infections, 8 (5.5%) had colitis, and 7.6 (5.0%) had pneumonia. Patients from whom gram-negative bacteria were isolated stayed in the hospital for longer duration compared to the other patients (median = 21.0 [19.0, 25.0] vs. 18.0 [15.0, 22.0] days, p-value = 0.043, respectively). The cumulative incidence of death in the first 100 days after infusion of stem cells was 3.4%. The cumulative incidence of death in the first 100 days post-transplantation was higher for patients with NHL compared to those with HL and MM (p-value = 0.017). Gram-negative and fungal infections were strong predictors of mortality. Conclusion Bacterial gram-positive and gram-negative infections were the most common early infections among patients who underwent autologous HSCT for hematological malignancies (HM) in the only center in Palestine. The findings of this study are informative to healthcare providers and planners of care for patients who are scheduled to receive autologous HSCT for HM. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07709-4.
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Affiliation(s)
- Riad Amer
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine. .,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine.
| | - Husam Salameh
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine. .,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine.
| | - Sultan Mosleh
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine.,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Adham Abu-Taha
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hamza Hamayel
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Enaya
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Amro Adas
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Khursani
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Mohamad Wild-Ali
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Taghreed Mousa
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Maher Battat
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Aiman Daifallah
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Amer Koni
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
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11
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Kumar L, Hussain MM, Chethan R, Sahoo RK, Malik PS, Sharma OD, Mathew A, Jha A, Gupta R, Sharma A, Biswas A, Kumar R, Thulkar S, Malik S, Dutt A. Multiple Myeloma: Impact of Time to Transplant on the Outcome. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e826-e835. [PMID: 35599086 DOI: 10.1016/j.clml.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is a standard therapy for transplant eligible patients of multiple myeloma (MM). To evaluate impact of time to transplant on subsequent outcomes, we analyzed data on consecutive MM patients who received novel agents-based induction prior to transplant. METHODS Between 2006 and 2019, 363 MM patients underwent ASCT. Patients' median age was 52 years, ranging from 20 to 72 years, 233 (64.2%) were males. Median interval from diagnosis to transplant was 11.5 months (range, 4-67.5); 201 (55.4%) patients underwent ASCT within 12 months (early) and 162 (44.6%) beyond 12 months since diagnosis (delayed ASCT). Primary objective was progression-free survival. Secondary objectives were-response rate to transplant, overall survival (OS), and transplant-related mortality (TRM). RESULTS Post-ASCT complete response (CR) (77.1% vs. 64.8%; P < .025) and CR+ very good partial response rate (89% vs. 81.5%; P < .03) was higher for early ASCT cohort. Engraftment characteristics, regimen-related toxicities, and day +100 TRM (3.5% vs 3.7%; P = .564) were similar in 2 cohorts. Median OS for early versus late cohort from date of diagnosis is 127.0 (95% CI, 98.9-155.1) versus 104.5 months (95% CI, 79.3-129.6; P = .356) and from date of transplant is 119.0 (95% CI, 93.4-144.6) versus 89.5 months (95% CI, 57.4-121.6), P < .02. Median PFS is better for early transplant cohort; 69.5 (95% CI, 56.7-82.3) versus 50.0 months (95% CI, 35.6-64.4), P < .05, respectively. CONCLUSION Early transplant for myeloma is associated with higher response rate and better progression-free survival.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Mohammad Mir Hussain
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajegowda Chethan
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Om Dutt Sharma
- Lab Oncology Unit, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Jha
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Lab Oncology Unit, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-Diagnosis, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Soumyaranjan Malik
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Dutt
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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12
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Kushwaha N, Kumar S, Sheikh MA, Philip J, Sharma S, Biswas AK, Joshi RK. Association of CD 34 positive cell dose with engraftment kinetics in autologous peripheral blood stem cell transplant patients of multiple myeloma. Med J Armed Forces India 2022; 78:296-301. [DOI: 10.1016/j.mjafi.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 01/17/2021] [Indexed: 11/28/2022] Open
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13
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Singh S, Sharma R, Singh J, Jain K, Paul D. Autologous stem cell transplantation for multiple myeloma in the novel agent era: Systematic review of Indian data and implications for resource constrained settings. J Cancer Res Ther 2022; 19:S12-S19. [PMID: 37147978 DOI: 10.4103/jcrt.jcrt_503_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Treatment of multiple myeloma has undergone significant advances in the last two decades, leading to meaningful improvement in overall and progression free survival. The incurable nature of disease necessitates serial sequencing of treatment options and continuous therapy once disease remission is achieved. Autologous stem cell transplantation (ASCT) has continued to offer a meaningful survival advantage with a consistent reduction in toxicity and costs. Despite the advent of newer drugs leading to deeper and sustained responses, ASCT continues to be the standard of care for all eligible patients and is ostensibly more cost effective than continued treatment with newer agents. However, ASCT continues to be underutilized in India, due to concerns about cost, safety, and sporadic expertize. We present a systematic review of available data on ASCT for multiple myeloma from India to evaluate safety and efficacy of the procedure, and provide evidence re-affirming its utility in resource constrained settings.
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14
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Sharma SK, Choudhary D, Doval D, Khandelwal V, Setia R, Dadu T, Handoo A. Hematopoietic Stem Cell Transplant for Hematological Malignancies: Experience from a Tertiary Care Center in Northern India and Review of Indian Data. South Asian J Cancer 2021; 11:62-67. [PMID: 35833052 PMCID: PMC9273315 DOI: 10.1055/s-0041-1731599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is the preferred treatment for high-risk and relapsed/refractory hematological malignancies. Moreover, with the improved supportive care and increasing acceptance of haploidentical transplantations as an alternative treatment modality, more patients are opting for HSCT as a definite treatment for hematological malignancies. We report here the real-world data and outcome of HSCT done for hematological malignancies at our transplant center. Five hundred and sixteen patients underwent HSCT from August 2010 to November 2019. The most common indications for allogeneic and autologous HSCT were acute myeloid leukemia and multiple myeloma, respectively. The 5-year overall survival and disease-free survival for all transplants were 65% and 33%, respectively. Though outcome of matched sibling donor allogeneic transplant is better than haploidentical donor (HID) transplant, patients having only HID can still be considered for allogeneic HSCT for high-risk diseases. The most common cause of death was infections followed by relapse of the disease.
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Affiliation(s)
- Sanjeev Kumar Sharma
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Dharma Choudhary
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Divya Doval
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Vipin Khandelwal
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Rasika Setia
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Tina Dadu
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
| | - Anil Handoo
- Center for Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India
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15
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Saeed N, Ahmad U, Moosajee M, Niazi ZAK, Siddiqui N, Aziz Z, Khan DH, Iftikhar F, Ahmad IN, Mir MA. A Multicenter Study of Clinical Presentations and Outcomes of Multiple Myeloma in Pakistan: The Real-World Analysis in a Resource-Constrained Country. Indian J Hematol Blood Transfus 2021; 38:309-318. [PMID: 35496958 PMCID: PMC9001789 DOI: 10.1007/s12288-021-01485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
This is the first multicenter study from Pakistan exploring the prevalence, clinical presentations and treatment outcomes of Multiple Myeloma patients. This retrospective study involved data collection from hospital record system of four tertiary care referral hospitals of Pakistan including all patients diagnosed as having Multiple Myeloma from January 2014 to December 2018. The demographic details, clinical presentations, laboratory findings, treatment responses, and mortalities were evaluated. The progression-free survival and overall survival were analyzed considering relapse and mortality as the end points, respectively. For the progression-free survival, the Kaplan-Meier survival analysis and the log rank test were used to compare the survival function for chemotherapy followed by autologous stem cell transplant (ASCT) as opposed to chemotherapy alone (non-ASCT). The overall survival analysis was assessed by Kaplan-Meier survival analysis. This study identified 403 Multiple Myeloma patients in five years. The median age at presentation was 55 years. Bortezomib based drug regimens were the most commonly used initial treatments (57.5%). Forty three patients received ASCT. The progression-free survival median for ASCT and non-ASCT patients were 50 months (95% CI, 42-57.9 months) and 26 months (95% CI, 21.5-30.5 months), respectively. The cumulative probability of survival rate at 60 months was 80%. This study identified 403 Multiple Myeloma patients over 5 years in four tertiary care hospitals of Pakistan. It underscores the importance of autologous stem cell transplant in Myeloma patients and advocates improving its facilities in Pakistan.
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16
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Sepehrirad S, Amanlou A, Bagherzadeh K, Azizian H, Amanlou M. Library-based lead compound discovery for CS-1 protein in multiple myeloma: homology modelling, molecular dynamic simulations, virtual screening and molecular docking. MOLECULAR SIMULATION 2021. [DOI: 10.1080/08927022.2021.1971225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shahrzad Sepehrirad
- Tehran University of Medical Sciences, International campus (TUMS-IC), Tehran, Iran
| | - Arash Amanlou
- Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kowsar Bagherzadeh
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
- Eye Research Center, The Five Senses Institute, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Azizian
- Department of Medicinal Chemistry, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Massoud Amanlou
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Kumar L, Gundu N, Kancharia H, Sahoo RK, Malik PS, Sharma A, Gupta R, Sharma O, Biswas A, Kumar R, Thulkar S, Mallick S. Multiple Myeloma-Effect of Induction Therapy on Transplant Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:80-90.e5. [PMID: 33129746 DOI: 10.1016/j.clml.2020.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with multiple myeloma (MM) aged ≤ 65 to 70 years, with a good Eastern Cooperative Oncology Group performance status and no major comorbid conditions, are considered potential candidates for autologous stem cell transplant (ASCT) and will be treated with novel agent-based induction therapy for 4 to 6 cycles before ASCT. PATIENTS AND METHODS We analyzed the data from 326 patients with MM who had received novel agent-based induction before ASCT at our center to evaluate the effect of induction therapy on ASCT response, stem cell mobilization, engraftment characteristics, and survival. The median age was 52 years (range, 29-72 years), 216 patients were men (66.3%), 32.7% had stage III using the Revised Multiple Myeloma International Staging System, and 15.8% had high-risk cytogenetics. Of the 326 patients, 75 (23.0%) had undergone ASCT in second remission after salvage therapy for relapse. Also, 194 patients (59.5%) had received doublet induction therapy and 132 (40.5%) had received triplet induction therapy. RESULTS Triplet-based induction therapy was superior to doublet-based therapy for response (95.4% vs. 84.02%; P < .003), stem cell mobilization (CD34+ ≥ 2 × 106/kg; 88.6% vs. 76.8%; P < .005), and lower 100-day transplant-related mortality (P < .001). The ≥100 day post-ASCT overall response (97.4% vs. 91.7%; P = .124) and complete response (72.5% vs. 68.0%; P = .38) rates were similar. At a median follow-up of 62.5 months, the overall survival (97.5 months vs. 100.0 months; P = .606) and progression-free survival (54.5 months vs. 57 months; P = .515) were similar between the triplet and doublet induction groups. CONCLUSION An initial response (chemosensitivity) to induction therapy will prepare patients better for subsequent consolidation therapy and ASCT, leading to favorable outcomes.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - Naresh Gundu
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Harish Kancharia
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Omdutt Sharma
- Department of Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Saumyaranjan Mallick
- Department of Pathology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Reinhold Munker
- Department of Internal Medicine, Division of Hematology & BMT, University of Kentucky, Lexington, KY 40536, USA
| | - Gregory Monohan
- Department of Internal Medicine, Division of Hematology & BMT, University of Kentucky, Lexington, KY 40536, USA
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Jain H, Thorat J, Sharma N. Multiple myeloma: The paradox and the challenge. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_75_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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