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OUTCOME IN TRANSPLANT ELIGIBLE PATIENTS WITH MULTIPLE MYELOMA IN LATIN AMERICA. AN INTERNATIONAL STUDY OF GELAMM

PS1402

Peña, C.1; Schutz, N. P.2; Bove, V.3; Villano, F.4; Osorio, R.5; Chandía, M.6; Cardemil, D.7; Contreras, C.8; Contreras, C. G.8; Donoso, J.9; Espinoza, M.10; Gabriel, L. R.11; López-Vidal, H.12; Rojas, C.13; Soto, P.14; Ochoa, P.15; Duarte, P.16; Remaggi, G.17; Yantorno, S.18; Corzo, A.19; Zabaljauregui, S.20; Shanley, C.21; Lopresti, S.22; Orlando, S.23; Verri, V.24; Quiroga, L.25; García, C. A.26; Fernández, V.27; Fantl, D.28; Riva, E.29

doi: 10.1097/01.HS9.0000563884.66165.e4
Poster Session II: Myeloma and other monoclonal gammopathies - Clinica
Free

1Hematology, Hospital del Salvador, Santiago, Chile

2Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

3Hospital de Clínicas, Montevideo

4CASMU, Montevideo, Uruguay

5Hospital de Arica, Arica

6Hospital Guillermo Grant Benavente, Concepción

7Hospital de Punta Arenas, Punta Arenas

8Hospital de Rancagua, Rancagua

9Hospital Sótero del Río

10Hospital San José, Santiago

11Hospital de Coyhaique, Coyhaique

12Hospital Barros Luco Trudeau, Santiago

13Hospital Gustavo Friecke, Viña del Mar

14Hospital de Puerto Montt, Puerto Montt, Chile

15Instituto Alexander Fleming

16CEMIC

17FUNDALEU, Buenos Aires

18Hospital Italiano, La Plata

19Hospital de Clínicas José de San Martín

20Academia Nacional de Medicina

21Hospital Británico

22Hospital Posadas, Buenos Aires

23Hospital Rossi, La Plata

24IDIM

25Hospital Churruca, Buenos Aires

26Clínica 25 de Mayo, Mar del Plata

27Hospital Méndez

28Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

29Hospital de Clínicas, Montevideo, Uruguay

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Background:

Multiple myeloma (MM) is a frequent hematologic malignancy. Despite the important advances in treatment strategies during the last decades, the gold standard remains being a proteasome inhibitor (PI)-based induction, followed by autologous stem cell transplant (ASCT).

In Latin America (LA) there is great heterogeneity in access to new drugs and ASCT, and there is scarce data regarding patient′s outcomes in the region.

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Aims:

The aim of this study was to describe clinical characteristics and outcomes of MM transplant eligible patients in LA countries.

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Methods:

Retrospective international multicenter cohort study. Unselected consecutive MM transplant- eligible patients diagnosed between 2010 and 2018 from participating centers in Chile, Argentina and Uruguay were included. Data was collected from clinical records in a standardized report form. We analyzed clinical characteristics at diagnosis and frontline therapy outcomes, including ASCT.

Transplant-eligible patients were defined as fit patients younger than 66 years old. Response to treatment was defined according to current IMWG criteria.

Statistical analysis was performed by using STATA 13.

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Results:

Six hundred and seventy one patients were included in the study, 282 from Chile, 258 from Argentina and 131 from Uruguay. The main characteristics are shown in Table 1. Significant differences in access to PI induction and ASCT were found between private and public institutions, with patients from the latter receiving suboptimal frontline therapy. Optimal response (sCR, CR and VGPR) was achieved in 51% of the patients in the CyBorD group, in 65% in the VTD group, and in 45% in the CTD group, the 3 main induction regimens used. Only 52% of patients finally underwent ASCT. With a median follow up of 33 months (range 1-109), 5 year overall survival (OS) was 58,4%, with a median survival of 73 months in the whole cohort. When analyzed according to induction treatment, 5 year OS was 74% for PI-based, 48% for thalidomide-based, and 23% for those not treated with novel agents (P < 0,0001). In the multivariable analysis, not undergoing ASCT (p < 0,001), renal failure (p = 0,004), hypercalcemia (p = 0,001), and achieving less than VGPR (p = 0,001) response were independent factors associated with worse outcome.

Figure

Figure

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Summary/Conclusion:

Survival in transplant-eligible patients is lower than the “optimal” described survival in other regions. Unequal access to PI-based regimens and therefore to ASCT between public and private centers was observed. Reasons for 48% of candidates not being transplanted merit further analysis.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.