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

Year 2023, Volume: 14 Issue: 3, 608 - 615, 30.09.2023
https://doi.org/10.18663/tjcl.1346448

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.

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References

  • Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019;37(14):1228-1263.
  • Kumar SK, Callander NS, Hillengass J, et al. NCCN guidelines insights: multiple myeloma, version 1.2020. J Natl Compr Canc Netw. 2019; 17(10):1154-1165
  • Jagannath S, Vesole DH, Glenn L, Crowley J, Barlogie B. Low-risk intensive therapy for multiple myeloma with combined autolo- gous bone marrow and blood stem cell sup- port. Blood. 1992;80(7):1666-1672.
  • Shah N, Callander N, Ganguly S, et al. Hematopoietic stem cell transplantation for multiple mye-loma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2015;21(7):1155-1166.
  • Giralt S. 200 mg/m(2) melphalan--the gold standard for multiple myeloma. Nat Rev Clin Oncol. 2010;7(9):490-491.
  • Badros A, Barlogie B, Siegel E, et al. Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol. 2001;114(3):600- 607.
  • Badros A, Barlogie B, Siegel E, et al. Results of autologous stem cell transplant in multiple mye-loma patients with renal failure. Br J Haematol. 2001;114(4):822-829.
  • Sweiss K, Patel S, Culos K, Oh A, Rondelli D, Patel P. Melphalan 200 mg/m2 in patients with renal impairment is associated with increased short-term toxicity but improved response and longer treatment-free survival. Bone Marrow Transplant. 2016;51(10):1337- 1341.
  • Katragadda L, McCullough LM, Dai Y, et al. Effect of melphalan 140 mg/m(2) vs 200 mg/m(2) on toxicities and outcomes in multiple myeloma patients undergoing single autologous stem cell transplantation-a single center experience. Clin Transplant. 2016;30(8):894-900.
  • Dhakal B, Nelson A, Guru Murthy GS, et al. Autologous hematopoietic cell transplantation in patients with multiple myeloma: effect of age. Clin Lymphoma Myeloma Leuk. 2017;17(3):165-172.
  • Gertz MA, Lacy MQ, Dispenzieri A, et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant. 2007;39(10):605-611.
  • Kumar SK, Dingli D, Lacy MQ, et al. Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: results from a matched pair analysis. Am J Hematol. 2008;83(8):614-617.
  • Garderet L, Beohou E, Caillot D, et al. Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study. Haematologica. 2016;101(11):1390- 1397.
  • Dimopoulos MA, Terpos E, Chanan-Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol. 2010;28(33):4976-4984.
  • Muchtar E, Dingli D, Kumar S, et al. Autologous stem cell transplant for multiple myeloma patients 70 years or older. Bone Marrow Transplant. 2016;51(11):1449-1455.
  • Auner HW, Iacobelli S, Sbianchi G, et.al. Melphalan 140 mg/m² or 200 mg/m² for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Out-comes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica. 2018 Mar;103(3):514-521. doi: 10.3324/haematol.2017.181339. Epub 2017 Dec 7.
  • Srour SA, Milton DR, Bashir Q, et.al. Melphalan dose intensity for autologous stem cell trans-plantation in multiple myeloma. Haematologica. 2021 Dec 1;106(12):3211-3214. doi: 10.3324/haematol.2021.279179.
  • Rajkumar SV, Dimopoulos MA, Palumbo A, et.al. International Myeloma Working Group up-dated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48. doi: 10.1016/S1470-2045(14)70442-5. Epub 2014 Oct 26.
  • Kumar S, Paiva B, Anderson KC, et.al. International Myeloma Working Group consensus crite-ria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016 Aug;17(8):e328-e346. doi: 10.1016/S1470-2045(16)30206-6.
  • Marini C, Maia T, Bergantim R, et al. Real-life data on safety and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma. Ann Hematol. 2019 Feb;98(2):369-379. doi: 10.1007/s00277-018-3528-x. Epub 2018 Oct 27.

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

Year 2023, Volume: 14 Issue: 3, 608 - 615, 30.09.2023
https://doi.org/10.18663/tjcl.1346448

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.

Project Number

No

References

  • Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019;37(14):1228-1263.
  • Kumar SK, Callander NS, Hillengass J, et al. NCCN guidelines insights: multiple myeloma, version 1.2020. J Natl Compr Canc Netw. 2019; 17(10):1154-1165
  • Jagannath S, Vesole DH, Glenn L, Crowley J, Barlogie B. Low-risk intensive therapy for multiple myeloma with combined autolo- gous bone marrow and blood stem cell sup- port. Blood. 1992;80(7):1666-1672.
  • Shah N, Callander N, Ganguly S, et al. Hematopoietic stem cell transplantation for multiple mye-loma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2015;21(7):1155-1166.
  • Giralt S. 200 mg/m(2) melphalan--the gold standard for multiple myeloma. Nat Rev Clin Oncol. 2010;7(9):490-491.
  • Badros A, Barlogie B, Siegel E, et al. Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol. 2001;114(3):600- 607.
  • Badros A, Barlogie B, Siegel E, et al. Results of autologous stem cell transplant in multiple mye-loma patients with renal failure. Br J Haematol. 2001;114(4):822-829.
  • Sweiss K, Patel S, Culos K, Oh A, Rondelli D, Patel P. Melphalan 200 mg/m2 in patients with renal impairment is associated with increased short-term toxicity but improved response and longer treatment-free survival. Bone Marrow Transplant. 2016;51(10):1337- 1341.
  • Katragadda L, McCullough LM, Dai Y, et al. Effect of melphalan 140 mg/m(2) vs 200 mg/m(2) on toxicities and outcomes in multiple myeloma patients undergoing single autologous stem cell transplantation-a single center experience. Clin Transplant. 2016;30(8):894-900.
  • Dhakal B, Nelson A, Guru Murthy GS, et al. Autologous hematopoietic cell transplantation in patients with multiple myeloma: effect of age. Clin Lymphoma Myeloma Leuk. 2017;17(3):165-172.
  • Gertz MA, Lacy MQ, Dispenzieri A, et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant. 2007;39(10):605-611.
  • Kumar SK, Dingli D, Lacy MQ, et al. Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: results from a matched pair analysis. Am J Hematol. 2008;83(8):614-617.
  • Garderet L, Beohou E, Caillot D, et al. Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study. Haematologica. 2016;101(11):1390- 1397.
  • Dimopoulos MA, Terpos E, Chanan-Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol. 2010;28(33):4976-4984.
  • Muchtar E, Dingli D, Kumar S, et al. Autologous stem cell transplant for multiple myeloma patients 70 years or older. Bone Marrow Transplant. 2016;51(11):1449-1455.
  • Auner HW, Iacobelli S, Sbianchi G, et.al. Melphalan 140 mg/m² or 200 mg/m² for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Out-comes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica. 2018 Mar;103(3):514-521. doi: 10.3324/haematol.2017.181339. Epub 2017 Dec 7.
  • Srour SA, Milton DR, Bashir Q, et.al. Melphalan dose intensity for autologous stem cell trans-plantation in multiple myeloma. Haematologica. 2021 Dec 1;106(12):3211-3214. doi: 10.3324/haematol.2021.279179.
  • Rajkumar SV, Dimopoulos MA, Palumbo A, et.al. International Myeloma Working Group up-dated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48. doi: 10.1016/S1470-2045(14)70442-5. Epub 2014 Oct 26.
  • Kumar S, Paiva B, Anderson KC, et.al. International Myeloma Working Group consensus crite-ria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016 Aug;17(8):e328-e346. doi: 10.1016/S1470-2045(16)30206-6.
  • Marini C, Maia T, Bergantim R, et al. Real-life data on safety and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma. Ann Hematol. 2019 Feb;98(2):369-379. doi: 10.1007/s00277-018-3528-x. Epub 2018 Oct 27.
There are 20 citations in total.

Details

Primary Language English
Subjects Haematological Tumours
Journal Section Research Article
Authors

Orhan Kemal Yücel 0000-0002-0455-1382

Project Number No
Publication Date September 30, 2023
Published in Issue Year 2023 Volume: 14 Issue: 3

Cite

APA Yücel, O. K. (2023). Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi. Turkish Journal of Clinics and Laboratory, 14(3), 608-615. https://doi.org/10.18663/tjcl.1346448
AMA Yücel OK. Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi. TJCL. September 2023;14(3):608-615. doi:10.18663/tjcl.1346448
Chicago Yücel, Orhan Kemal. “Multiple Myelom hastalarında Otolog Hematopoietik kök hücre Naklinin Ilk 100 gün sonuçları: Melfalan 200 mg/m² ’ye karşı Melfalan 140 mg/M² hazırlama Rejimi”. Turkish Journal of Clinics and Laboratory 14, no. 3 (September 2023): 608-15. https://doi.org/10.18663/tjcl.1346448.
EndNote Yücel OK (September 1, 2023) Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi. Turkish Journal of Clinics and Laboratory 14 3 608–615.
IEEE O. K. Yücel, “Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi”, TJCL, vol. 14, no. 3, pp. 608–615, 2023, doi: 10.18663/tjcl.1346448.
ISNAD Yücel, Orhan Kemal. “Multiple Myelom hastalarında Otolog Hematopoietik kök hücre Naklinin Ilk 100 gün sonuçları: Melfalan 200 mg/m² ’ye karşı Melfalan 140 mg/M² hazırlama Rejimi”. Turkish Journal of Clinics and Laboratory 14/3 (September 2023), 608-615. https://doi.org/10.18663/tjcl.1346448.
JAMA Yücel OK. Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi. TJCL. 2023;14:608–615.
MLA Yücel, Orhan Kemal. “Multiple Myelom hastalarında Otolog Hematopoietik kök hücre Naklinin Ilk 100 gün sonuçları: Melfalan 200 mg/m² ’ye karşı Melfalan 140 mg/M² hazırlama Rejimi”. Turkish Journal of Clinics and Laboratory, vol. 14, no. 3, 2023, pp. 608-15, doi:10.18663/tjcl.1346448.
Vancouver Yücel OK. Multiple myelom hastalarında otolog hematopoietik kök hücre naklinin ilk 100 gün sonuçları: melfalan 200 mg/m² ’ye karşı melfalan 140 mg/m² hazırlama rejimi. TJCL. 2023;14(3):608-15.


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