Clinical features and survival of 338 multiple myeloma patients treated with hematopoietic stem cell transplantation or conventional chemotherapy

• Published in: European journal of haematology Vol. 96; no. 4; pp. 417 - 424
• Main Authors: Pérez, Raúl, Durán, Mª Sol, Mayans, Jose, Soler, Alfons, Castillo, Inmaculada, Jurado, Manuel, Ribas, Paz, Menchaca Echevarria, Mª Carmen, Hernandez, Miguel T., Lopez Garcia-Carreño, Mª Dolores, Echeveste Gutierrez, Asunción, Bailen Garcia, Alicia, Lopez, Silvia, Baquero, Jose, Ramirez, Gemma
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-04-2016
• Subjects: Adult; Aged; Aged, 80 and over; Anemia - complications; Anemia - diagnosis; Anemia - mortality; Anemia - therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; beta 2-Microglobulin - blood; conventional therapy; Creatinine - blood; Female; Hematopoietic Stem Cell Transplantation; Humans; Hypercalcemia - complications; Hypercalcemia - diagnosis; Hypercalcemia - mortality; Hypercalcemia - therapy; Induction Chemotherapy - methods; Male; Middle Aged; multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - diagnosis; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Neoplasm Staging; newly diagnosed patients; Retrospective Studies; Survival Analysis; survival rate; Transplantation, Autologous; hematopoietic stem cell transplantation; survival rate; multiple myeloma; newly diagnosed patients; conventional therapy
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.12611

Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II‐III MM who started first‐line treatment over a 2‐yr period (2003–2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2‐microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First‐line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3‐yr survival (85% vs. 49.7%; 95% CI, range 77–91 vs. 41–58; P < 0.001). Overall, 55% of patients presented treatment‐related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating‐based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up‐front high‐dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.