scholarly journals G-CSF Mobilization Alone, a Shorter Duration of Neutropenia, and the Rapidity of Engraftment Are Associated with Engraftment Syndrome in Patients Undergoing Autologous PBSCT for Multiple Myeloma

2012 ◽  
Vol 18 (2) ◽  
pp. S276
Author(s):  
B. Burnette ◽  
A. Dispenzieri ◽  
L. Porrata ◽  
W. Hogan ◽  
S. Holtan
Keyword(s):  
Multiple Myeloma ◽  
Engraftment Syndrome ◽  
Autologous Pbsct

Recovery Of Natural Killer Cells and Monocyte Subsets Following Autologous Peripheral Blood Stem Cell Transplantation Predicts Longer Progression Free Survival Among Multiple Myeloma Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2126-2126 ◽  
Author(s):  
Natalie S Callander ◽  
Paul J Rathouz ◽  
Fotis Asimakopoulos ◽  
Mark B Juckett ◽  
Christopher L Coe ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Peripheral Blood Stem Cell ◽  
Nk Cell ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Free Survival ◽  
Cell Counts ◽  
Autologous Pbsct ◽  
Blood Stem Cell Transplantation

Abstract Prior research has shown that a timely immune recovery following peripheral blood stem cell transplantation (PBSCT) may improve progression free and overall survival for lymphoma and leukemia patients (pts). However, this has not been studied in multiple myeloma (MM) pts. We conducted an exploratory investigation of the extent to which the recovery of Natural Killer (NK) cell and monocyte (Mo) subsets predicted progression free survival (PFS) among MM pts following autologous PBSCT. Patients (N = 37) were treated with 200mg/m2 of melphalan, followed by infusion of >2 x106 CD34 cells/kg, and were followed prospectively for 3 to 36 months. Immunophenotyping and multicolor flow cytometry were used to identify NK and Mo subsets at Day 100 post-PBSCT. Disease progression or relapse was defined using IMWG criteria. Cox proportional hazard regression models were used to examine relationships between cell subpopulation counts and time from PBSCT to MM progression. All models were adjusted for ISS stage and risk (high, defined as plasma cell leukemia; loss of p53, myc rearrangement, t(14;16), t(14:20) by FISH; minus 13 by cytogenetics; versus standard) at diagnosis, and hazard ratios were standardized to correspond to a 2 standard deviation difference in the logarithm of NK or Mo cell counts. Compared to a healthy reference sample, MM patients showed good recovery of all Mo subsets with normal counts by Day 100, but CD56+CD3- NK cell numbers remained low, with the subset of NK cells expressing high CD16 particularly suppressed. During the follow-up period, 25 patients (67.6%) progressed or relapsed. Pts with higher Day 100 CD56+CD16hi NK cell counts had a longer PFS (hazard ratio = .351, p = .033). A similar effect was seen for CD56+CD16lo NK cells (hazard ratio = .321, p = .079). Higher CD14+ Mo counts were also associated with longer PFS (hazard ratio = .230, p = .007). An examination of Mo subpopulations showed that higher numbers of Mo expressing low or no CD16 predicted a longer time to disease progression (hazard ratio = .207, p = .011), but the inflammatory subsets with moderate or high CD16 expression were not significantly associated with PFS. Results suggest that MM patients who have lower NK cell and CD14+ Mo counts may be at risk for a poorer outcome following autologous PBSCT, with these subsets adding prognostic significance above and beyond cytogenetic risk and ISS stage. Subpopulations with greater regulatory and less inflammatory function had the most salient effects. These NK cell and Mo subsets may inhibit residual MM growth and progression and could serve as novel markers of the clinical outcome following PBSCT for MM. Disclosures: No relevant conflicts of interest to declare.

Patients with Relapsed or Progressive Multiple Myeloma Treated with Lenalidomide in the Compassionate Use Program. Spanish Registry, Preliminary Analysis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4821-4821
Author(s):  
Adrian Alegre ◽  
B. Aguado ◽  
A. Alonso ◽  
V. Anso ◽  
C. Cabrera ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Trials ◽  
Plasma Cells ◽  
Standard Dose ◽  
Response Assessment ◽  
Practical Experience ◽  
Compassionate Use ◽  
Clinical Criteria ◽  
Autologous Pbsct

Abstract Introduction and Objectives. Lenalidomide is a new inmunomodulatory drug which has shown effectiveness, in combination with dexamethasone, in relapsed or progressive Multiple Myeloma (MM). In our country, little experience outside clinical trials exists since lenalidomide is only currently available in the compassionate use program, for patients with advanced MM. With the purpose of sharing the clinical practical experience with this drug, we considered it interesting to gather the outstanding data on the use of lenalidomide in a multicentric registry, throughout the Spanish scope. We present the preliminary results of this registry. Patients and methods. We designed a registry, canalized through GEM-PETHEMA, in which main clinical data of MM patients relapsed or progressive treated with lenalidomide within the compassionate use program, were collected. The decision to treat these patients was prior to and independent of the decision to make this registry and was only based on clinical criteria. The selected patients had at least one response assessment. Results. 19 valid questionnaires have been received, 14 patients (pts.) being assessable for response. The treatment was started between 03/06 and 04/07. Average age: 63 years (40–77); 9 men and 5 women. Type of MM: IgG 9 pts, IgA 3 pts, 1 non-secretory, 1 Bence Jones K. Average M-protein 3.25 g/dL(SD: 3,32); average creatinine 1,05 (SD: 0.36); average bm plasma cells infiltration: 36%. Median lines of previous treatments: 4 (2–8). 13 pts had received bortezomib, 8 pts had received thalidomide, and 7 had undergone autologous PBSCT. 7 pts showed extramedullary plasmocytomas.2 patients received the standard dose (25 mg daily, P.O. 21 days every 4 weeks). 2 patients received lower doses. All the patients, except one, received Dexamethasone simultaneously (average 56 mg per week). Prophylaxis for DVT: 7 pts with LWMH and 3 pts with salicylates. 4 patients did not receive prophylaxis. At the time of data collection 10 patients where still on the treatment. Lenalidomide was discontinued in 2 patients due to progression (median time to progression 6 months (1–8); 1 pts underwent PBSCT after reaching PR and discontinued the treatment due to stable disease after 6 months. Response: 2 CR (14%), 1 VGPR (7%), 6 PR (43%), 3 SD (21%). Among the 9 pts with a favorable response (64%): 8 had previously received bortezomib, 4 had received thalidomide, and 4 had undergone PBSCT - Toxicity: Neutropenia G3: 5 pts/G4: 2 pts; 5 patients needed G-CSF. Thrombocytopenia G3: 3 pts/G4: 3 pts. Skin rash in 1 pt. Neither TVP/TEP nor neutropenic fever were observed. Conclusions. Although a more detailed analysis and a longer follow-up is needed the results of our registry are consistent with other published clinical trials: lenalidomide associated with dexamethasone induces durable objective responses in a high percentage of patients with relapsed or progressive MM, after several treatment lines. The tolerance of this drug is acceptable, being the mielosuppression the most relevant toxicity. The role of this drug at low dose for long term maintenance have to be investigated.

A phase II study of lenalidomide consolidation and maintenance therapy after autologous PBSCT in patients with multiple myeloma

2018 ◽  
Vol 109 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Shin-ichi Fuchida ◽  
◽  
Kazutaka Sunami ◽  
Morio Matsumoto ◽  
Hirokazu Okumura ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Autologous Pbsct

scholarly journals Thalidomide as salvage therapy for VAD-refractory multiple myeloma prior to autologous PBSCT

2002 ◽  
Vol 29 (7) ◽  
pp. 577-580 ◽  
Author(s):  
I Ahmad ◽  
T Islam ◽  
A Chanan-Khan ◽  
T Hahn ◽  
D Wentling ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Salvage Therapy ◽  
Refractory Multiple Myeloma ◽  
Autologous Pbsct

Evaluating the incidence of engraftment syndrome with different melphalan formulations in adult multiple myeloma and immunoglobulin light chain amyloidosis patients undergoing autologous hematopoietic cell transplantation

2021 ◽  
pp. 107815522098762
Author(s):  
Kaitlyn E Kowalski ◽  
Sarah E Wheeler ◽  
C Brooke Adams ◽  
Stacy A Voils ◽  
Ashley I Richards
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Light Chain ◽  
Potential Risk ◽  
Hematopoietic Cell Transplantation ◽  
Immunoglobulin Light Chain ◽  
Potential Risk Factors ◽  
Engraftment Syndrome ◽  
Immunoglobulin Light Chain Amyloidosis ◽  
Autologous Hematopoietic Cell Transplantation

Background Engraftment syndrome (ES) is a common complication of autologous hematopoietic cell transplantation (HCT). The difference in incidence of ES between melphalan formulations has not been widely reported throughout the literature and would allow for a more comprehensive understanding of the advantages and disadvantages of both melphalan formulations. Patients and methods This retrospective, single-center, observational study evaluated 83 adult multiple myeloma and immunoglobulin light chain amyloidosis patients who received either propylene glycol-containing (PG) or propylene glycol-free (PG-free) melphalan 140 mg/m2 as single-agent conditioning chemotherapy for autologous HCT from May 31, 2015 to May 31, 2019. The primary outcome was to assess the incidence of ES, as defined using the Maiolino criteria, with both melphalan formulations. Secondary outcomes included an analysis of potential risk factors for the development of ES, as well as an evaluation of overall length of stay (LOS). Results The incidence of ES for PG and PG-free melphalan did not differ significantly, 14/39 (35.9%) and 12/44 (27.3%) (P = 0.4), respectively. No potential risk factors for ES were identified on multivariate logistic regression analysis. A statistically significant difference in number of days to engraftment was identified for PG and PG-free melphalan, 15.56 vs. 13.82 days (P = 0.01), respectively; although, this did not translate to a decrease in LOS, 19.9 vs. 18.59 days (P = 0.14). Conclusions The incidence of ES did not differ significantly between melphalan formulations. Future research is needed to determine whether the faster time to engraftment seen with PG-free melphalan may translate to a decrease in LOS.

High Rate of Engraftment Syndrome in Elderly Patients with Multiple Myeloma Receiving Autologous Peripheral Blood Stem Cell Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3175-3175
Author(s):  
Phyllis McKiernan ◽  
David Siegel ◽  
David H. Vesole ◽  
Themba Nyirenda ◽  
Scott D. Rowley ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Hepatic Dysfunction ◽  
Peripheral Blood Stem Cell ◽  
Lower Number ◽  
Engraftment Syndrome

Abstract In recent years, engraftment syndrome (ES) has been more clearly defined in the autologous transplant setting. It represents a group of symptoms that includes fever, diarrhea, rash, pulmonary infiltrates and hepatic dysfunction, and has been associated with increased morbidity and longer hospitalization. It has also been proposed that ES may be protective against relapse. This study cohort includes 146 patients who received 181 autologous peripheral blood stem cell transplants (PBSCT) for multiple myeloma between January 2010 and December 2014. Thirty five patients received tandem PBSCT, including 1 patient who had 3 PBSCT. Of the patients in the cohort, 63% were male, median age was 59.7 years (range 53.8 - 66.9 years) and median follow-up was 24.1 months (range 0.5 - 64.5 months). Standard definition for ES was used: at least 2 symptoms not attributed to other causes including non-infectious fever >100.4, diarrhea, skin rash, pulmonary infiltrates or hepatic dysfunction, occurring from 3 days prior to 10 days post engraftment. There were 63 occurrences of ES by defined criteria. Seven patients did not require treatment, 56 patients were treated with corticosteroids, and 2 patients required the addition of tacrolimus. Potential risk factors for the development of ES were analyzed including age, stage of disease, high-risk cytogenetics or FISH, number and type of prior regimens, mobilization regimen, number of CD34 positive cells infused, and the disease status at the time of PBSCT. Patients above the age of 60 had a 66.7% incidence of ES whereas patientsunder the age of 60 had a 49.1% incidence. By univariate analysis, significant factors included age > 60 (p=0.037), lower number of CD34 positive cells infused (p=0.0031), and greater than 3 prior regimens excluding mobilization (p=0.0174). Two separate multivariate analyses revealed that developing ES was significantly associated with age > 60 (p=0.0372) and lower number of CD34 positive cells infused (p=0.0076). There was a trend (p=0.11) for increased incidence of ES in patients who did not receive cyclophosphamide for stem cell mobilization. For patients who developed ES, the OS at 5 years was 51.2% versus 73.1% for patients without ES (p=0.0194). Patients under the age of 60 with ES had a significant decrease in overall survival (p=0.0095) .The median progression free survival (PFS) in the overall cohort was 32.5 months, with no significant difference between the two groups. Advanced age and lower number of CD34 positive cells infused were associated with an increased risk for the development of ES, and there was a trend for the use of cyclophosphamide for mobilization as being protective against ES. Development of ES was significantly associated with an increase in all-cause mortality. There appears to be no protective benefit of ES against relapse. Awareness that the elderly population of myeloma patients receiving autologous stem cell transplantation is more susceptible to the development of ES may help in early diagnosis and treatment. Preventative measures such as cell dose and the use of cyclophosphamide warrant further evaluation. Figure 1. Overall Survival of patients post PBSCT for multiple myeloma Figure 1. Overall Survival of patients post PBSCT for multiple myeloma Figure 2. Overall Survival of patients <60 years old post PBSCT for multiple myeloma Figure 2. Overall Survival of patients <60 years old post PBSCT for multiple myeloma Disclosures Siegel: Celgene Corporation: Consultancy, Speakers Bureau; Amgen: Speakers Bureau; Takeda: Speakers Bureau; Novartis: Speakers Bureau; Merck: Speakers Bureau. Vesole:Celgene Corporation: Speakers Bureau; Idera Pharmaceuticals: Research Funding. Skarbnik:Genentech: Honoraria, Speakers Bureau; Gilead Sciences: Honoraria, Speakers Bureau; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Increased fecal primary bile acids in multiple myeloma with engraftment syndrome diarrhea after stem cell transplant

2019 ◽  
Vol 54 (11) ◽  
pp. 1898-1907
Author(s):  
Priya Vijayvargiya ◽  
Wilson Gonsalves ◽  
Duane Burton ◽  
William J. Hogan ◽  
Teresa Miceli ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Bile Acids ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Engraftment Syndrome
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