1085P - First 100 days outcome of autologous non-cryopreserved peripheral blood stem cell transplants in multiple myeloma

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Myeloproliferative Neoplasms
Presenter Smita Kayal
Authors S. Kayal1, V. Raina2, A. Sharma1, R. Kumar3, S. Iqbal1
  • 1Dept. Of Medical Oncology, All India Institute of Medical Sciences (AIIMS) Institute Rotary Cancer Hospital, 110029 - New Delhi/IN
  • 2Dept. Of Medical Oncology & Haematology & Stem Cell Transplant, All India Institute of Medical Sciences (AIIMS) Institute Rotary Cancer Hospital, 110029 - New Delhi/IN
  • 3Lab Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN

Abstract

Background

We report the outcome of autologous stem cell transplant (ASCT) in multiple myeloma (MM) after high dose melphalan with peripheral blood stem cell (PBSC) rescue without cryopreservation in terms of feasibility, safety and 100 day morbidity and mortality.

Methods

Between Sept 1994 and Feb 2012 a total of 81 patients (56 males, 25 females) were treated with non cryopreserved ASCT, with conditioning regimen of high dose melphalan 140-200 mg/m2 given on day-1. PBSC was collected after G-CSF mobilization with a mean number of leukapheresis of 1.5 (range 1-3) and was stored at 40C for 1-3 days (median = 2) before reinfusion on day 0. The median MNC was 3.0 x 108/kg (range 0.99 – 8.07) and CD34 dose was 2.34 x 106/kg (range 0.18 – 7.67).

Results

Median age was 50 years (range 22-65). The median time from diagnosis to transplant was 12.1 months (range 4.3 - 99.9). Prior to transplant, 67 patients (83%) had chemosensitive disease (CR, VGPR, PR) and 13(16%) had chemoresistant (stable, refractory or progressive) disease. Forty five (55%) patients had an ECOG PS of 0-1. The median score for hematopoietic cell transplant comorbidity index (HCT-CI) was 0 (range 0-6). The median time to neutrophil engraftment was 10 days (range 8-27) and platelet engraftment was 14 days (range 9-38). Febrile neutropenia occurred in 98.7% patients with a clinically defined focus observed in 14.8%, microbiologically documented infection in 27.1% and fever of unknown origin in 56.7% cases. Antibiotics were used for a median of 10 days (range 5-42). Total toxicity score (sum of toxicity grades for all organs as per Seattle criteria) ranged from 0-13 (median =2) and the median length of hospital stay (LOS) was 18 days (range 12-62). Day 100 mortality was 2.4% (n = 2). Disease status post transplant was CR in 14.8%, VGPR in 60.4% and PR in 11.1% with stable or refractory disease in 8.6%. LOS significantly correlated with age ≥ 50 yrs and HCT-CI of > 0 (p = 0.028 and 0.007 respectively) but not with ECOG PS (p = 0.28). Cumulative toxicity score had no significant correlation with either age, HCT-CI or PS.

Conclusion

ASCT in MM using non cryopreserved PBSC graft is safe and effective. It may be a prudent alternative with potential for wider applicability.

Disclosure

All authors have declared no conflicts of interest.