Efficacy of reduced dose melphalan conditioning for multiple myeloma patients undergoing autologous stem cell transplantation: in the era of combined induction with novel agents

Year 2021, Volume: 4 Issue: 2, 203 - 208, 28.03.2021

Bahar Uncu Ulu Mehmet Bakırtaş Tuğçe Nur Yiğenoğlu Semih Başcı Jale Yıldız Derya Şahin Tahir Darçın Alparslan Merdin Hikmetullah Batgi Dicle İskender Nuran Ahu Baysal Sinan Dal Merih Kızıl Çakır Fevzi Altuntaş

https://doi.org/10.32322/jhsm.868279

Abstract

Introduction / Aim: Melphalan 200 mg/m2 (MEL 200) is known as the standard conditioning regimen for Multiple Myeloma (MM) patients in autologous stem cell transplantation(ASCT). Most of the studies showing the superiority of MEL 200 versus melphalan 140 mg/m2 (MEL 140) were performed in the era of conventional chemotherapies. However, today, several novel agents such as proteasome inhibitors, immunomodulatory agents have been introduced in MM treatment algorithms. There is limited data on the impact of this dose reduction on progression-free survival (PFS) or overall survival (OS). The present study compares MEL 140 and MEL 200 conditioning for ASCT in patients treated with combination therapy of bortezomib‑containing induction.
Material and Method: Results of 84 MM patients who underwent ASCT at our center between 2010 and 2018 were analyzed retrospectively.
Findings / Results: In the MEL 140 group, PFS was 9 months (%95 CI 2.2-15.8) and OS was 30 months ( %95CI 9.5-50.4), while PFS was 13 months ( %95CI 10.5-15.5) and OS was 34 months( %95CI 6.9-61) in the MEL 200 group. There was no statistically significant difference in PFS and OS between the two groups (p:0.6, p:0.7).
Conclusion: Consequently, MEL 140 and MEL 200 were found similar in terms of engraftment duration, transplant-related mortality rate, and survival rates. The idea that similar outcomes in both MEL 140 and MEL 200 group in patients who received combined induction treatment with novel agent suggested that MEL 140 may be used more commonly than the standard approach of MEL 200.

ÖZET
Giriş: Multipl Myeloma (MM) tedavisinde 200 mg/m2 melfalan (MEL 200) otolog kök hücre nakli (OKHN) için standart hazırlama rejimi olarak kabul edilmiştir. MEL 200’ün 140 mg/m2 melfalan’a (MEL 140) üstünlüğünü gösteren çalışmaların çoğu konvansiyonel kemoterapiler döneminde yapılmıştır. Ancak günümüzde MM tedavisine immünmodulatuvar, proteozome inhibitörü gibi birçok yeni ajan katılmıştır. Bu çalışmada indüksiyon tedavisinde bortezomib içeren kombinasyon tedavisi almış hastaların otolog kök hücre nakli ile konsalidasyonunda MEL 140 ve MEL 200’un karşılaştırılması hedeflendi.
Materyal Metot: 2010-2018 yılları arasında merkezimizde OKHN olmuş 84 MM hastasının sonuçları geriye dönük olarak analiz edildi.
Bulgular: MEL 140 grubunda progresyonsuz sağkalım (PFS) 9 ay (%95 CI 2.2-15.8), genel sağkalım (OS) 30 ay (%95CI 9.5-50.4) saptanırken MEL 200 grubunda PFS 13 ay ( %95CI 10.5-15.5) , OS 34 ay ( %95CI 6.9-61) saptandı. Her 2 grup arasında PFS ve OS açısından istatistiksel olarak anlamlı bir fark saptanmadı (sırasıyla p:0.6; p:0.7).
Sonuç: Sonuç olarak, engraftman süreleri, transplant ilişkili mortalite oranı ve sağkalım oranları açısından MEL 140 ve MEL 200 benzer bulundu. İndüksiyon tedavisinde yeni ajanlar ile kombine tedaviler almış olan hastalarda MEL 140 ve MEL 200 arasında OS ve PFS farkı olmaması, standart yaklaşım olan MEL 200 yerine MEL 140’ın daha yaygın kullanabileceği fikrini doğurmuştur.

Keywords

Melphalan, Autologous Stem Cell Transplantation, Multiple myeloma, 200 mg/m2, 140 mg/m2

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