Autologous stem cell transplant for multiple myeloma: Impact of melphalan dose on the transplant outcome

Abstract

We evaluated impact of melphalan dose on transplant outcomes for multiple myeloma. Between 1995 and 2019 459 consecutive patients received a transplant; 69(15%) received melphalan ≤150 mg/m2 (Mel 150 cohort) and 390 (85%) melphalan 200 mg/m2 (MEL 200 cohort). The primary outcome was overall survival (OS) from the date of transplant. Progression-free survival (PFS), engraftment, transplant response, and cumulative relapse at 2 years were secondary outcome measures. Patients in Mel 150 cohort had adverse clinical and laboratory parameters at base line. Transplant response was better for Mel 200 cohort (p < 0.024). Median OS at a median follow-up of 88 months was similar in the two cohorts; 100 Vs 102 months (Mel 200), p = 0.817. Median PFS (60.0 Vs 53 months, p = 0.746), relapse at two years (32.4% Vs 30.9%, p = 0.745) and grade 3-4 mucositis (p = 0.823) were similar. Initial treatment prepares patients better for subsequent similar transplant outcomes despite differences in baseline characteristics.

Keywords:

• Comorbidities
• Transplant toxicity
• Transplant Outcome
• Melphalan dose
• Relapse
• HCT CI
• Engraftment characteristics

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We gratefully acknowledge the excellent care provided by the transplant team.

Author contributions

Lalit Kumar conceptualized, designed the study, analyzed the data and wrote the manuscript.

Ranjit Kumar Sahoo Clinical management, reviewed the manuscript, and discussion.

Sudhir Kumar Clinical management.

Annie K Baa Clinical management.

Ghazal Tanshir Clinical management.

Neha Pathak Clinical management.

Prabhat S Malik clinical management and suggestions for analysis,

Om Dutt Sharma Performed myeloma studies

Ritu Gupta Myeloma studies review of bone marrow smears.

Anisha Mathew: Assembly of data.

Ankit Jha Assembly of data.

Atul Sharma Clinical management.

Ahitagni Biswas Clinical management and radiation therapy.

Rakesh Kumar Imaging including PET/CT scan.

Sanjay Thulkar: Imaging.

Soumyaranjan Malik Review of bone marrows.

Ashish Dutt statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author on request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.