Haematologica 2003 - Supplements

10. Stem and cell transplantation
10.1 Prognostic factors and results with single
ASCT.
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HIGH-DOSE THERAPY AUTOTRANSPLANTATION/
INTENSIFICATION IN MULTIPLE MYELOMA (MM):
PRETRANSPLANT PREDICTORS OF COMPLETE
REMISSION (CR)
E. Giné, E. Nadal, J. Bladé, J. Esteve, F. Fernández-
.Avilés, C. Martínez, M. Rovira, A. Urbano-Ispizua, P.
Marín, B. Nomdedeu, E. Carreras, E. Montserrat.
Institute of Hemato-Oncology, Hematology Department, BMT
Section, Blood Bank. Hospital Clínic IDIBAPS, Barcelona.
Background: High-dose therapy (HDT) followed by stem cell
support is widely used as intensification treatment in patients
with MM responsive to the initial chemotherapy. However, there
is growing evidence that only patients achieving CR benefit from
this approach.
Aim: To identify pretransplant predictors of CR in responding
myeloma patients intensified with HDT.
Patients and Methods: From June 1992 to August 2001, 59
patients (37 M, 22 F; median age 54 years, range 38-69) with
chemosensitive disease received myeloablative therapy. The M-
protein type was IgG in 32, IgA in 13, light-chain in 12 and IgD
and non-secretor one case each. The initial chemotherapy
consisted of MP (6 cases), alternating combination chemotherapy
VCMP/VBAP or BVMCP/VBAD (44) and VAD or VBAD (11).
The intensification regimen consisted of: Mel-140/TBI 12 Gys
(21), MEL-200 (23) or busulphan-based regimens (15).
Results: The response rate to the initial chemotherapy was: CR
8%, PR 70% and MR 22%. Complete resmission after HDT was
achieved in 22 of the 59 patients (37 %). No patient died from
transplant-related toxicity or while in response. The median EFS
and OS from the initiation of therapy were 41 and 68 months,
respectively. Patients who achieved CR had an EFS (median, 47
vs 36 months; p=0.023) as well as an OS (median, not reached vs
60 months; p= 0.006) significantly longer than those attaining a
lower degree of response. The pretransplant features significantly
associated to CR were a low M-protein size (serum ≤10 G/L and
urine < 0.5 g/24 h) (p< 0.0001) and a percentage of bone marrow
plama cells ≤ 5 % (p= 0.03). There was also a trend towards a
lower CR rate in patients with a Hb level < 11 g/dL (p= 0.055).
At the logistic regression analysis only the M-protein size
retained its statistical significance (p= 0.008).
Conclusion: These results confirm the achievement of CR after
HDT as the crucial step for long-lasting disease control and
prolonged survival in MM. The critical factor predicting CR is
the tumour burden at the time of transplant measured by the M-
protein size.
260
Population–based study of the ‘young’ myeloma
population: only a minority of potentially eligible
patients with myeloma receive stem cell
transplantation; a study of the contributory factors.
TCM Morris*, E Ranaghan*, C Ogilvie, GH Jackson, MR
Velangi
*Belfast City Hospital for Northern Ireland Haematology Group,
Royal Victoria Infirmary, Newcastle-Upon-Tyne for the Northern
Regional Haematology Group.
Autologous transplantation is recognised as the standard of care
for younger patients with myeloma. Clinical trials do not
represent fully the spectrum of patients who present with
myeloma in this age group. The aim of this survey was to
identify the number of patients, eligible by age, who had failed to
receive a transplant, the reasons for this, what proportion of these
patients might in different circumstances have been transplanted
and to identify if there was unmet need for transplantation. A
preliminary six month survey was undertaken by identifying all
eligible (by age) transplant recipients in two regions (a) in
Northern Ireland and (b) Northern Region (England) using the
well established haematological malignancy data registries in
these regions. A one page questionnaire was completed for each
of the patients who had not received peripheral blood stem cell
transplantation. We found that only 50% of patients aged 60 or
under had received a transplant. Early death, co-morbidity, poor
response to therapy and failed peripheral blood stem cell harvests
were the main reasons for non-transplantation. Less than 20% of
patients between 60 and 70 were transplanted with co-morbidity
and patient choice being the main reasons for non-transplantation.
We have now extended this survey to take in all patients aged
under 65 years diagnosed with myeloma between January 2000
and December 2001 in these two regions. 48 and 134 patients
have been transplanted prior to March 2003. The wide range of
reasons for non-transplantation in the remaining 86 cases will be
presented in detail.
261
Autologous Transplantation in Rare Myelomas; an
EBMT study of patient characteristics, transplant rated
factors and outcome
TCM. Morris*, M. Drake*, T. Löppönen**, B. Bjorkstrand**,
G. Gahrton**, J. Apperley+
*Haematology Department, Belfast City Hospital, Northern Ireland;
**Huddinge University Hospital, Stockholm, Sweden; +Royal Post
Graduate Medical School, Hammersmith Hospital, London
Most myelomas are IgG, IgA or Bence-Jones Protein only
idiotypes. In contrast, IgD and non-secretory (NS) myelomas are
uncommon while IgM and IgE myelomas are very rare. While
survival in IgD myeloma is generally accepted to be poor than for
common myelomas, the situation for NS, IgM and IgE myeloma
is less clear; little is known about the impact of conventional
transplant strategies on the outcome of any of these myelomas.
We have therefore used the European Blood & Marrow
Transplant Group (EBMT) myeloma database to study these
patients and their outcome. The analysis is restricted to patients
in whom Med B forms have been submitted; these contain
considerably more information than the Med A (registration)
forms but not all fields are completed by all investigators. A total
of 10467 Med B records were studied from which 580 patients
with rare myelomas were identified; common myelomas 9887,
IgD 135; IgE 5, IgM 10; NS 415. IgD and NS myeloma were
both at a more advanced stage at diagnosis with a greater
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