The Impact of Bone Marrow Fibrosis on Transplant Outcomes in Multiple Myeloma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation

Yıl 2024, , 340 - 348, 14.10.2024

Ebru Kılıç Güneş , Meltem Aylı

https://doi.org/10.52827/hititmedj.1501040

Öz

Objective: In newly diagnosed multiple myeloma, bone marrow fibrosis is observed in 8-57% of cases. In this retrospective study, we aimed to investigate the clinical and demographic characteristics of multiple myeloma patients with bone marrow fibrosis, as well as the impact of bone marrow fibrosis on engraftment and transplant outcomes following autologous hematopoietic stem cell transplantation.
Materials and Method: Our study included 78 newly diagnosed multiple myeloma patients who received induction therapy and underwent autologous hematopoietic stem cell transplantation at our center between August 2016 and July 2023.
Results: Bone marrow fibrosis (grade I-III) was detected in 37 patients (47.5%). Patients with bone marrow fibrosis had a significantly higher percentage of bone marrow plasma cells compared to those without fibrosis (50% vs 35%, p=0.007). After autologous hematopoietic stem cell transplantation, time to neutrophil and platelet engraftment were significantly longer in the group with bone marrow fibrosis (Median time to neutrophil engraftment day:14 vs 13 days, p=0.005, Median time to platelet engraftment day:16 vs 13 days, p=0.004). The length of hospital stay after autologous hematopoietic stem cell transplantation was significantly longer in the group with bone marrow fibrosis (22 days vs 19 days, p=0.047). No significant differences were found regarding neutrophil and platelet engraftment days when considering clinical, demographic, and other transplant-related factors.
Conclusion: In conclusion, our study found that newly diagnosed multiple myeloma patients with bone marrow fibrosis had longer neutrophil and platelet engraftment times and longer hospital stays after autologous hematopoietic stem cell transplantation. There is a need for larger prospective studies to determine the optimal amount of CD34 (+) stem cells and to explore more effective use of supportive therapies and growth factors in this patient group.

Anahtar Kelimeler

Autologous Hematopoietic Stem Cell Transplantation, Bone Marrow Fibrosis, Multiple Myeloma, Neutrophil Engraftment, Platelet Engraftment

Otolog Hematopoetik Kök Hücre Nakli Yapılan Multiple Myelom Hastalarında Kemik İliği Fibrozisinin Nakil Sonuçlarına Etkisi

Öz

Amaç: Yeni tanı multiple myelomda kemik iliğinde fibrozis %8-57 arasında görülmektedir. Bu retrospektif çalışmamızda, kemik iliğinde fibrozis olan multiple myelom hastalarının klinik ve demografik özellikleri ile kemik iliği fibrozisinin otolog hematopoetik kök hücre nakli sonrası engrafmana ve nakil sonuçlarına etkisini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmamıza, Ağustos 2016 ile Temmuz 2023 tarihleri arasında merkezimizde multiple myelom tanısı ile indüksiyon tedavisi verilen ve otolog hematopoetik kök hücre nakli yapılan 78 hasta dahil edildi.
Bulgular: Hastaların 37’sinde (%47,5) kemik iliğinde grade I-III fibrozis saptanmıştır. Kemik iliğinde fibrozis saptanan hastalarda kemik iliği plazma hücre oranı anlamlı daha yüksek tespit edilmiştir (%50 vs %35, p=0,007). Fibrozisi olan ve olmayan multiple myelom hastalarının diğer klinik ve demografik özellikleri benzerdir. Otolog hematopoetik kök hücre naklinde verilen CD34(+) kök hücre miktarları ve melfalan dozları da her iki grup arasında benzerdir. Otolog hematopoetik kök hücre nakli sonrası, nötrofil ve trombosit engrafmanı, kemik iliğinde fibrozis olan grupta anlamlı olarak daha uzun tespit edilmiştir (Medyan nötrofil engrafman günü: 14 vs 13 gün, (p=0,005), medyan trombosit engrafman günü: 16 vs 13.gün, (p=0,004). Otolog hematopoetik kök hücre nakli sonrası hastanede kalış süresi, kemik iliğinde fibrozis olan grupta anlamlı daha uzun tespit edilmiştir (22 gün vs 19 gün, p=0,047). Hastaların nötrofil ve trombosit engrafman günü üzerine etki edebilecek diğer hasta, hastalık ve transplant ilişkili diğer faktörler açısından anlamlı fark tespit edilememiştir.
Sonuç: Çalışmamız sonucunda, kemik iliğinde fibrozis tespit edilen, yeni tanı multiple myelom hastalarında otolog hematopoetik kök hücre nakli sonrası nötrofil ve trombosit engrafman günü ile hastanede kalış süresi daha uzun saptanmıştır. Bu hasta grubunda optimal CD34(+) kök hücre miktarının belirlenmesi, destek tedavilerin ve büyüme faktörlerinin daha etkin kullanımı ile ilgili daha geniş prospektif çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

Multiple Myeloma, Otolog Kök Hücre Nakli, Kemik İliği Fibrozisi, Nötrofil Engrafmanı, Trombosit Engrafmanı

Etik Beyan

Çıkar Çatışması: Yazarlar olarak, herhangi bir çıkar çatışması olmadığını beyan ederiz. Finansal Destek: Bu Klinik araştırma, kamu, ticari veya kar amacı gütmeyen sektörlerdeki finansman kuruluşlarından herhangi bir finansal destek ya da özel hibe almamıştır. Etik Kurul onayı: 22.08.2023 tarihli ve 2023-312 numaralı Sağlık Bilimleri Üniversitesi Gülhane Tıp Fakültesi Etik Kurulu tarafından onaylanmıştır. Çalışmaya dahil edilen tüm bireysel katılımcılardan bilgilendirilmiş onam alınmıştır.

Destekleyen Kurum

Yok

Teşekkür

Dr. Ahmet Kürşad Güneş

Kaynakça

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