MM-517 Outcome of Autologous Stem Cell Transplantation in High-Risk Multiple Myeloma: A Single-Center Experience

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2024-09, Vol.24, p.S565-S565
• Main Authors: Pincha, Rajat, Ghosh, Shouriyo, Podder, Dibakar, Kumar, Jeevan, Nag, Arijit, Javed, Rizwan, Chattopadhyay, Debranjani, Mishra, Deepak, Parihar, Mayur, Nair, Reena
• Format: Article
• Language: English
• Subjects: ASCT; high risk; high-dose melphalan; multiple myeloma; ultra-high-risk
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01695-1

Autologous stem cell transplantation (ASCT) is still standard of care consolidative treatment in fit patients with myeloma. To assess the outcomes of ASCT in high-risk newly diagnosed multiple myeloma (NDMM). Outcomes, including progression-free survival (PFS) and overall survival (OS) were determined. A total of 169 ASCTs were performed between January 2012 and December 2023 at our institute. Of these, 37 ASCTs for NDMM with high-risk cytogenetics were analyzed in the present study. High-risk cytogenetics were defined as per the Mayo Stratification for Myeloma and Risk-Adapted Therapy (m-SMART) cytogenetic risk group. Categorical and continuous variables were presented as counts (with respective percentages) and median values (with range), respectively. Kaplan-Meier product-limit-estimate was used to calculate OS and PFS. The median patient age was 52.6 years (range, 29-65), and males constituted 62.1% of patients (23/37). 1q gain was the most common abnormality (18/37, 48.6%). Ten patients had ultra- high-risk disease (with 2 or more high-risk cytogenetic abnormalities). The most common prior therapy was bortezomib-thalidomidedexamethasone in 16 of 37 patients. In terms of pretransplant response, 94.5% of the patients were in VGPR or better at the time of transplantation. GCSF + plerixafor mobilization was used in 21 of 37 patients. Twenty-five patients received conditioning with melphalan 200 mg/m2 while the rest received a lower dose as per creatinine clearance (140 mg/m2). Median CD34 stem cell dose/kg body weight was 5.96 million/kg (range, 3.4-13.4). The median number of days to neutrophil and platelet engraftment was 10 (8-11) and 11 days (9-14), respectively. Posttransplant maintenance was either with lenalidomide or bortezomib-lenalidomide. The median follow-up was 32.53 months (range, 19.74-45.31). The median PFS was 42 months (95% CI, 16.68-67.31). Median OS was not reached. Estimated 5-year overall survival was 64.8% (±8.6%). These results describe the considerably favorable outcomes in a high-risk subset of patients with myeloma undergoing ASCT consolidation.