The First 100-day Outcomes of Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma Patients: Melphalan 200 mg/m² versus 140 mg/m² Conditioning Regimen

Abstract

Aim: Melphalan 200 mg/m² (Mel200) is a standard accepted conditioning regimen during the autologous hematopoietic stem cell transplantation (auto-HSCT) for multiple myeloma (MM) patients. Whereas melphalan 140 mg/m² (Mel140) is generally preferred either in patients with renal disease or elderly patients. We aimed to compare the first 100-day outcomes of the Mel140 and Mel200 conditioning after auto-HSCT in this study. Material and Methods: We retrospectively analyzed 69 consecutive MM patients who underwent their first auto-HSCT at the Adult Hematopoietic Stem Cell Transplantation Unit at Akdeniz University Hospital. Results: The ratio of patients with glomerular filtration rate (GFR)<60 ml/min was significantly higher in the Mel140 group than the Mel200 group (P < 0.001). Despite not to reach statistical significance, the median age tended to be higher in the Mel140 group (P = 0.064). There were not any significant difference between the Mel200 and Mel140 groups in terms of hospitalisation time at transplantation (P = 0.691), neutrophil engraftment time (P = 0.907), platelet engraftment time (P = 0.234), febrile neutropenia during the transplantation (P = 1), number of erythrocyte transfusion during the hospitalisation (P = 0.661), number of platelet transfusion during the hospitalisation (P = 0.569), patient status at post-transplant day 100 (P = 0.882), and disease status at post-transplant day 100 (P = 0.967), respectively. Conclusion: Our study shows that the Mel200 and Mel140 conditioning have similar first 100-day outcomes after auto-HSCT in MM. Further comprehensive randomised trials would clarify the impact of melphalan conditioning intensity on early term post-transplant outcomes.

Keywords

• multiple myeloma
• autologous hematopoietic stem cell transplantation
• melphalan
• early term post-transplant outcomes

Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² 'ye karşı melfalan 140 mg/m² hazırlama rejimi

Abstract

Amaç: Melfalan 200 mg/m² (Mel200), multiple myelom (MM) hastaları için otolog hematopoietik kök hücre nakli (oto-HKHN) sırasında standart olarak kabul edilen bir hazırlama rejimidir. Melfalan 140 mg/m² (Mel140) ise genellikle böbrek hastalığı olan hastalarda veya yaşlı hastalarda tercih edilir. Bu çalışmada oto-HKHN sonrası Mel140 ve Mel200 hazırlama rejimlerinin ilk 100 günlük sonuçlarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Akdeniz Üniversitesi Hastanesi Erişkin Hematopoietik Kök Hücre Nakli Ünitesinde ilk oto-HKHN uygulanan ardışık 69 MM hastasını retrospektif olarak inceledik. Bulgular: Hastaların 41'i (%59,4) erkek, 28'i (%40,6) kadındı. Hastaların nakil sırasındaki ortanca yaşı 61 idi (aralık, 40-75). Glomerüler filtrasyon hızı (GFR) <60 ml/dk olan hastaların oranı Mel140 grubunda Mel200 grubuna göre anlamlı olarak daha yüksekti (P < 0.001). İstatistiksel anlamlılığa ulaşmamakla birlikte, medyan yaş Mel140 grubunda daha yüksek olma eğilimindeydi (P = 0.064). Mel200 ve Mel140 grupları arasında sırasıyla transplantasyonda hastanede kalış süresi (P = 0.691), nötrofil engraftman süresi (P = 0.907), trombosit engraftman süresi (P = 0.234), transplantasyon sırasında febril nötropeni gelişimi (P = 1), hastanede yatış sırasında eritrosit transfüzyonu sayısı (P = 0.661), hastanede yatış sırasında trombosit transfüzyonu sayısı (P = 0.569), nakil sonrası 100. gündeki hasta mortalite oranı (P = 0.882) ve nakil sonrası 100. gündeki hastalık durumu (P = 0.967) açısından anlamlı fark yoktu. Sonuç: Çalışmamız, oto-HSCT sonrası ilk 100 gün sonuçlarının Mel200 ve Mel140 hazırlama rejimlerini kullanan MM hastalarında benzer olduğunu göstermektedir. Daha kapsamlı randomize klinik çalışmalar melfalan hazırlama rejimi yoğunluğunun nakil sonrası erken dönem sonuçlarına olan etkisini açıklığa kavuşturacaktır.

Keywords

• multiple myelom
• otolog hematopoietik kök hücre nakli
• melfalan
• nakil sonrası erken dönem sonuçları

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