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Objective: Complete remission in multiple myeloma (MM) is a defined as having a <5% bone marrow plasma cell (BMPC) ratio plus negative serum and urine immunofixation tests. However, it is necessary to reassess whether or not the bone marrow plasma cell ratio should be determined before transplantation in secretory multiple myeloma patients. A significant decrease in monoclonal protein levels or having negative serum and urine immunofixation tests after induction therapy might be enough to indicate chemo-sensitivity.
Material and Methods: In this study, the data of 177 multiple myeloma patients that underwent autologous stem cell transplantation (ASCT) in our center were retrospectively evaluated.
Results: We found a statistically significant difference in the post-ASCT response rates between the patients with a pre-ASCT BMPC ratio <5% vs BMPC ratio ≥5% (p:<0.001*). The 2-year progression-free survival (PFS) of the patients with BMPC ratio <5% and ≥5% post-ASCT was found 24% and 25% (median PFS 11 months (95% CI; 6,68-15,31) vs 12 months (95% CI; 9,47-14,53)) respectively (p: 0.900). The 2-year overall survival (OS), was 67% and 63% (median OS 35 months (95% CI; 25,59-44,41) vs 40 months (95% CI; 27,52-52,47)) respectively (p: 0.341).
Conclusion: Patients with decreasing monoclonal protein in serological tests, the pre-ASCT BMPC ratio was not found to have an impact on neutrophil and platelet engraftment durations, transplantation related mortality (TRM), PFS and OS. Our study suggests that in MM patients with measurable disease, it is not required to evaluate the BMPC ratio if serologic response exists.
2. Kumar SK, Rajkumar SV, Dispenzieri A et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.
3. Kastritis E, Zervas K, Symeonidis A et al. Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG). Leukemia 2009; 23: 1152–1157.
4. Kyle RA, et al. Long-term survival in multiple myeloma. N Engl J Med. 1983; 308(6): 314–316.
5. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21–33.
6. Palumbo A, Cavallo F. Have drug combinations supplanted stem cell transplantation in myeloma? Hematology Am Soc Hematol Educ Program 2012; 2012: 335–341.
7. Harousseau JL. Autologous transplantation for multiple myeloma. Ann Oncol 2008; 19 (Suppl 7): vii128–vii133.
8. Bladé J, Samson D, Reece D, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol. 1998; 102(5):1115-1123.
9. Kyle RA and Rajkumar SV, “Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma,” Leukemia 2009; vol.23, no.1, pp.3–9.
10. Rajkumar SV, Fonseca R, Dispenzieri A et al., “Effect of complete response on outcome following autologous stem cell transplantation for myeloma,” Bone Marrow Transplantation 2000; vol.26, no.9, pp.979–983.
11. Rajkumar SV, Fonseca R, Lacy MQ, et al., “Beta2-microglobulin and bone marrow plasma cell involvement predict complete responders among patients undergoing blood cell transplantation for myeloma,” Bone Marrow Transplantation 1999; vol.23, no.12, pp.1261–1266.
12. Kim JS, Kim K, Cheong J-W, Min YH, Suh C, Kim H, et al. Complete Remission Status Before Autologous Stem Cell Transplantation Is an Important Prognostic Factor in Patients with Multiple Myeloma Undergoing Upfront Single Autologous Transplantation. Biol Blood Marrow Transplant [Internet]. 2009; 15(4):463–70.
13. Dreger P, Klöss M, Petersen B et al. Autologous progenitor cell transplantation: prior exposure to stem cell-toxic drugs determines yield and engraftment of peripheral blood progenitor cell but not of bone marrow grafts Blood 1995; 86: 3970-3978
14. Schmitz N, Linch DC, Dreger P et al. Randomized trial of filgrastim-mobilized peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients (erratum: Lancet 1996; 347: 914) Lancet 1996; 347: 353-357
15. Davies SM, Kollman C, Anasetti C et al. Engraftment and survival after unrelated-donor bone marrow transplantation: a report from the national marrow donor program Blood 2000; 96: 4096-4102
16. Bensinger WI, Martin PJ, Storer B et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers New Engl J Med 2001; 344: 175-181
17. Laughlin MJ, Barker J, Bambach B et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors New Engl J Med 2001; 344: 1815-1822
18. Durie BG, Harousseau JL, Miguel JS et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.
19. Lee S-E, Yahng S-A, Cho B-S, Eom K-S, Kim Y-J, Kim H-J, et al. Lymphocyte subset analysis for the assessment of treatment-related complications after autologous stem cell transplantation in multiple myeloma. Cytotherapy 2012; 14(4):505–512.
20. Lee S-E, Yoon J-H, Shin S-H, Eom K-S, Kim Y-J, Kim H-J, et al. Bone Marrow Plasma Cell Assessment before Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation. BioMed Research International 2014; Volume 2014, Article ID 982504, https://doi.org/10.1155/2014/982504