Autologous stem cell transplantation (ASCT) prolongs progression free survival (PFS) in newly diagnosed multiple myeloma (MM) patients in the era of novel therapy. However, the outcome of MM patients from the Middle East and North Africa (MENA) is much less known particularly due to the paucity of SCT centers and heterogeneous health care delivery models.
To examine the outcome of newly diagnosed MM patients in a relatively new HSCT center in Saudi Arabia.
This is a retrospective analysis of all MM patients that underwent ASCT at our center since launching the program in 2010 until 2018. All data were retrieved from electronic medical records. Baseline patient characteristics, disease and treatment related variables were reported using descriptive statistics (frequency, median and percentage). Estimates of overall survival (OS) and PFS were computed using Kaplan-Meier method. The treatment protocol include induction phase with bortezomib based triplet regimen such as VD, VCD or VRD followed by stem cell mobilization with cyclophosphamide 3 gm/m2 + GCSF 10 mcg/kg. This was followed by melphalan conditioning 200 or 140 mg/m2. Post HCT, 2 consolidation cycles of VCD or VRD were followed by lenalidomide or bortezomib maintenance for 2 years.
A: Baseline Characteristics. A total of 60 patients were identified and males represented 65% of the cohort. The median age was 53 years (31-70). ISS stage I, II and III were 25, 27 and 45% respectively. Mean LDH and serum creatinine were 243 U/L and 127 mmol/L respectively. Disease subtype was IgG kappa or lambda in 45%, light chain kappa or lambda in 28%, IgA kappa or lambda in 18% and others in 9%. Normal cytogenetic was seen in 57% while the remaining comprised of hyperdiploidy in 22%, complex cytogenetic (>2 abnormalities) in 12%, t (11:14) in 6% and 1.5% with trisomy 3 and no cytogenetic result available in the remaining 1.5%. Disease status pre-HCT was stringent complete response (sCR) in 21/60 (35%) patients, complete response (CR) in 17/60 (28%) patient, very good partial response (VGPR) in 10/60 (17%) patient, partial response (PR) in 11/60 (18%) patient and in 1/60 (2%) patient no documentation was available.
B: Post ASCT Outcome. The median duration for absolute neutrophil count (ANC) and platelet engraftment was 13 and 14 days respectively. Primary graft failure was observed in one patient (1.7%) leading to transplant related mortality. Evaluable response by day 100 was available in 55 patients and were; sCR 26/55 (47%) patient, CR 17/55 (31%) patient, VGPR 11/55 patient (20%) and disease progression (DP) in 1/55 (2%) patient. Median follow up was 828 days (18-2790). Estimates of PFS at 100 days, 1 year and 5 years were 98.3%, 84.5% and 43.1% respectively while corresponding OS was 98.3%, 94.3% and 70.5% respectively (Fig 1A/B). PFS and OS for combined high risk and non-high risk MM patients at 3 years from CIBMTR were 43% and 78.5% respectively.
We observed comparable post ASCT outcome in our emerging transplant center compared with well-established centers worldwide. Given that AHCT remains underutilized in the MENA region, reporting of such data highlights that increased access to such therapy will be of great value to the region.