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Abdrabou AK, Al Sharif F, El Fakih R, Zahrani HA, Al Yamany R, Saleh M, Alhayli S, Al Somali Z, Alotaibi A, AlShaibani A, Deeba F, Asif M, Ahmed SAOA, Al Fraih F, Shaheen M, Alahmari A, Rasheed W, Chaudhri NA, Al Mohareb F, Aljurf M, Hanbali A. Improved long-term survival rate in the responders to bortezomib, cyclophosphamide, dexamethasone induction therapy in a transplant-eligible cohort of predominantly middle-age multiple myeloma patients. Ann Saudi Med 2024; 44:93-103. [PMID: 38615184 PMCID: PMC11016155 DOI: 10.5144/0256-4947.2024.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/08/2023] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) represents the second most common hematologic malignancy (15%). Induction with bortezomib, cyclophosphamide, and dexamthasone VCd (d: low dose dexamthasone) regimen is widely used due to its high effectiveness, low toxicity and good tolerability, particularly with renal impairment. Real-world data on the use of VCD in clinical practice is lacking. OBJECTIVES Evaluate the real-world experience of the VCD regimen. DESIGN Retrospective. SETTING Tumor registry database of tertiary cancer care center. PATIENTS AND METHODS newly diagnosed MM patients who received VCD induction and underwent autologous stem cell transplant (ASCT) from July 2007 to July 2020. MAIN OUTCOME MEASURES response evaluation, progression-free survival (PFS) and overall survival (OS). SAMPLE SIZE 87 patients. RESULTS Of 102 patients who started induction with VCd, 87 patients experienced a partial response or more overall response rate of 85%). The median age of these 87 patients at diagnosis was 52 years, of which 29.9% presented with renal impairment and 60.3% of patients had stage 2 by the Revised International Staging System (R-ISS). Patients with a standard cytogenetic risk achieved a better response compared to those with a poor cytogenetic risk (P=.044). The post-induction response rates were 6.9% stringent complete remission (sCR), 35% complete remission (CR); 41.4% very good partial response (VGPR), and 16.1% partial response (PR), respectively; the response rates became greater for sCR and CR post-transplantation at day 100 with 16.1% sCR, 35.6% CR, 32.2% VGPR and 16.1% PR, respectively. The median PFS was 49 months and 5 years OS was 84%. PFS was better in patients who achieved sCR vs PR (83 vs 35 months, P=.037). High LDH, high-risk cytogenetic and stage 3 R-ISS showed a worse median PFS and OS. CONCLUSIONS VCD induction in newly diagnosed MM is highly effective, convenient, tolerable and affordable regimen, especially in low and middle-income countries with limited resources, also with favorable outcomes and survival. while those who did not respond successfully shifted to VRD or VTD. LIMITATIONS The usual limitations of a retrospective analysis using registry-level data, no data on quality of life.
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Affiliation(s)
- Ahmed Kotb Abdrabou
- From the Department of Hematology and Bone Marrow Transplant, Zagazig University, Zagazig, Egypt
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fahad Al Sharif
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riad El Fakih
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hazaa Al Zahrani
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ruah Al Yamany
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mostafa Saleh
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saud Alhayli
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Zakia Al Somali
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmad Alotaibi
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - AlFadel AlShaibani
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Farah Deeba
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maryam Asif
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Syed Ahmed Osman Ali Ahmed
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Feras Al Fraih
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marwan Shaheen
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alahmari
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Walid Rasheed
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Naeem Arshad Chaudhri
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fahad Al Mohareb
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amr Hanbali
- From the Adult Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abdrabou AK, Sharif FA, Fakih RE, Hashmi S, Khafaga YM, Alhayli S, Zahrani HA, Ahmed S, Fraih FA, Shaheen M, Rasheed W, Chaudhri NA, Mohareb FA, Khalil H, Aljurf M, Hanbali A. Outcomes of autologous stem cell transplantation for multiple myeloma in Saudi Arabia. Ann Saudi Med 2021; 41:198-205. [PMID: 34420396 PMCID: PMC8380276 DOI: 10.5144/0256-4947.2021.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In 2015, multiple myeloma (MM) represented 1% of all cancers and about 5% of hematologic malignancies in Saudi cancer registry. We conducted this large study because only small pilot studies have examined MM outcomes after autologous stem-cell transplantation (ASCT). The standard therapy for eligible patients is induction chemotherapy followed by ASCT. OBJECTIVES Determine the demographic characteristics of MM patients and the outcomes of ASCT. DESIGN Retrospective. SETTING Tumor registry database of major tertiary cancer care center in Riyadh. PATIENTS AND METHODS We identified patients with newly diagnosed MM who underwent ASCT from October 1997 to March 2015. MAIN OUTCOME MEASURES The demographic characteristics of MM patients and the outcomes of ASCT in the form of response evaluation, progression-free survival (PFS) and overall survival (OS). SAMPLE SIZE 169 patients with newly diagnosed MM. RESULTS The median age at diagnosis was 51 years (range 23-69) and 100 (59.2%) were male. The most common immunoglobulin (Ig) subtype was IgG-kappa (80 patients; 47.6%). Most patients presented with advanced ISS stage III (75 patients; 47.5%). The cytogenetic analysis was documented in only 87 patients (51.4%); about half (48.3%) had normal cytogenetics by fluorescence in situ hybridization. Deletion 13 was present in 18.4% of patients. In post-induction therapy, 84 patients (50%) achieved a complete response, which increased to 78.1% (132 patients) after ASCT. The median PFS and OS post-transplantation were 30 and 202 months, respectively. Only one patient (<1%) died in the first 100 days after transplantation. CONCLUSIONS Our transplant eligible MM patients tend to be younger with a higher OS and a low ASCT-related mortality (<1%) than is reported internationally. LIMITATIONS Usual limitations of a retrospective analysis using registry-level data; no data on quality of life. CONFLICTS OF INTEREST None.
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Affiliation(s)
- Ahmed Kotb Abdrabou
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,From the Department of Medicine, Hematology Unit, Zagazig University, Zagazig, Egypt
| | - Fahad Al Sharif
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yasser Mohamed Khafaga
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saud Alhayli
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hazaa Al Zahrani
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Syed Ahmed
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Feras Al Fraih
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Marwan Shaheen
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naeem Arshad Chaudhri
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Al Mohareb
- From the King Faisal Cancer Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hala Khalil
- From the Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amr Hanbali
- From the Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Abstract
A 26-year-old female presented with an episode of severe mucus membrane bleeding. Investigations revealed prolonged prothrombin time (PT), and partial thromboplastin time (PTT), normal thrombin time (TT) and reptilase time, thrombocytopenia, a positive test for lupus anticoagulant (LA), as well as anti-cardiolipin antibodies (ACL). A toxicology screen for toxic drugs and coumadin was negative. Coagulation factor assays revealed low levels for factor II and XII. Low level inhibitor to factor II was demonstrated. Patient had a negative VDRL test and positive anti-nuclear antibodies (ANA). The diagnosis of acquired hypoprothrombinaemia secondary to circulating inhibitor induced by LA was made, and then the patient was started on prednisone, which led to cessation of the bleeding and normalization of PT and PTT, as well as an increase of factor II and factor XII levels. A few months later, the patient developed arthralgia and alopecia, and antibodies against double-stranded DNA were detected, and the diagnosis of systemic lupus erythematosis (SLE) was confirmed. The patient continued to have mild prolongation of PT and PTT while on a low dose of prednisone, but she had no bleeding symptoms. A computed tomography scan of the brain was carried out for unexplained central nervous system (CNS) symptoms, and it revealed mild hydrocephalus, which was thought to be part of the CNS manifestations of SLE. It was concluded that patients with SLE may present with haemostatic defects that are a result of either platelet-related causes (quantitative or qualitative) or coagulation factor deficiency secondary to circulating inhibitor, or both, in the absence of other features of SLE which may appear later.
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Affiliation(s)
- O Ayoub
- Section of Adult Hematology and Bone Marrow Transplantation, Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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