scholarly journals Induction chemotherapy before autologous stem cell transplantation for symptomatic plasma cell myeloma – does it matter?

2010 ◽  
pp. 71
Author(s):  
Henry Fung
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Induction Chemotherapy ◽  
Plasma Cell ◽  
Plasma Cell Myeloma

High Incidence of Transient Monoclonal Gammopathies after Allogeneic Hematopoietic Stem Cell Transplantation in Non-Myeloma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2206-2206
Author(s):  
Corinne C Widmer ◽  
Urs Schanz ◽  
Alexandre PA Theocharides
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Plasma Cell ◽  
Healthy Subjects ◽  
Monoclonal Gammopathy ◽  
Plasma Cell Myeloma ◽  
Hematopoietic Stem ◽  
High Incidence

Abstract Background The clinical and biological relevance of a monoclonal gammopathy (MG) that newly arises after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in non-myeloma patients is unknown. In healthy subjects, the incidence of monoclonal gammopathy of undetermined significance (MGUS) ranges from 3-9% and significantly increases with age. In these individuals, the absolute risk of progression to plasma cell myeloma at 20 years is 5-58%, depending on the MGUS subtype. The aim of this study was to investigate the incidence, the course and the clinical relevance of post-allo-HSCT MG. Methods We retrospectively analyzed a cohort of 403 non-myeloma patients (median age: 48y, range: 18-69y, 57% men, 43% women) who underwent allo-HSCT at the Division of Hematology of the University Hospital Zurich between January 2004 and December 2014. In these patients, a serum electrophoresis and an immunofixation was performed every 3-6 months post allo-HSCT. Patients with a MGUS before allo-HSCT were excluded from the study. The immunoglobulin subtype and the light chain restriction of the MG were determined by immunofixation. The most frequent indications for allo-HSCT were acute leukemia (AL, n=305), chronic myeloid leukemia (CML, n=30), myelodysplastic syndrome (MDS, n=24), and myeloproliferative neoplasm (MPN, n=20). Results The incidence of a MG after allo-HSCT (56/403 patients, 14%) was higher than the reported incidence of MGUS in age-matched healthy subjects (estimated prevalence of MGUS in 50y old men: 3.2%) and in contrast to healthy subjects did not correlate with age. The majority of patients carried a IgG paraprotein (80%), while IgM paraproteins were detected in 12.5% of patients. Rarely, two types of paraproteins were identified simultaneously in the same patient. In most patients (44/56, 79%), the MG appeared within the first year after allo-HSCT and was transient with a median duration of 5.8 months (range 2.5 - 43.9 months). However, in 7/56 (13%) patients, the MG persisted until the end of the observation period (median duration 33 months, range 12-45.6 months). Only one patient showed a very late (7y post allo-HSCT) but also transient appearance of a MG. Development of plasma cell myeloma was not observed in patients with post allo-HSCT MG. Conditioning regimen, GvHD, immunoglobulin treatment and cessation of immunosuppressive therapy did not predict the appearance of post allo-HSCT MG. Conclusions Our study reveals a high incidence of a transient MG after allo-HSCT that is not related to age of the recipient and follows the expected immunoglobulin subtype distribution. Importantly, patients with post allo-HSCT were not at increased risk of developing plasma cell myeloma as observed for MGUS in otherwise healthy subjects inferring a distinct pathogenetic mechanism. The transient nature of MG early after allo-HSCT suggests an association with the immune reconstitution process and future studies will determine whether expansion of a specific plasma cell clone can occur during engraftment of donor-derived hematopoiesis. Disclosures Theocharides: Novartis: Consultancy, Honoraria.

Autologous Stem Cell Transplantation after FLAG-IDA Chemotherapy for High-Risk Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemias Secondary to MDS (sAML) Does Not Improve Outcome: A PETHEMA Experience in 103 Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 793-793
Author(s):  
Guillermo F. Sanz ◽  
Armando V. Mena-Duran ◽  
Jose M. Ribera ◽  
Teresa Bernal ◽  
Luis Palomera ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Induction Chemotherapy ◽  
Autologous Transplantation ◽  
Refractory Anemia ◽  
Homogeneous Population

Abstract Background. AML conventional chemotherapy followed or not by autologous stem cell transplantation could be curative for high risk MDS and sAML. Aim. To evaluate outcome in 103 patients enrolled in PETHEMA’s FLAG-IDA protocol achieving complete remission (CR) followed by intensive chemotherapy and autologous transplantation compared to those with no further treatment. Patients and methods. 103 patients were recruited from 15 institutions starting December 1997 till December 2004. Eligibility criteria: de novo MDS with Spanish score >2 and/or International Prognostic Scoring System (IPSS) >1; or sAML. Induction chemotherapy was the FLAG-IDA regime (Fludarabine, cytarabine (ARA-C), idarubicin (IDA) and G-CSF). Patients achieving complete remission (CR) had consolidation chemotherapy with IDA+ARAC+G-CSF. Patients younger than 65 yrs old who mobilized enough hematopoietic progenitors proceeded to autologous stem cell transplantation. Poor mobilizers were treated further either with allogeneic transplantation, if an appropriate donor was available, or with carboplatin (CBDCA) intensification. For patients older than 65 yrs CBDCA intensification was the only therapeutic option. Results. Patients had a median age of 62 yr (range, 17–79) with a M:F ratio of 2.4:1. According to FAB classification, 2 patients had refractory anemia (RA), 1 had refractory anemia with ringed sideroblastos (RARS), 37 had refractory anemia with excess of blasts (RAEB), 23 had RAEB in transformation (RAEB-t) and 40 (39%) had sAML. Unfavorable cytogenetics according to the IPSS was found in 46 patients (45%). According to IPSS (if suitable), 9 patients were Intermediate-1, 21 Intermediate-2 and 23 were high-risk. According to the Spanish score, 3 patients had low-risk, 29 had intermediate-risk and 31 had high-risk. Sixty-six patients (64%) achieved CR and 37 patients (46%) failed (13 patients achieved partial remission; 12 had refractory disease and 12 patients died in aplasia). No variable correlated with the achievement of CR. With a median follow-up of 16 months (range, 1–80), 31 patients remained alive in continuous CR. The median event-free survival (EFS) was 11 months (range, 2–59) and the projected 3-year EFS was 29% (95% CI, 14–44). Multivariate analysis for EFS revealed poor-risk cytogenetics according to IPSS (P=0.005) as the only independent prognostic factor associated with relapse or death. Actuarial median and 3-year EFS for the 23 patients who proceeded to autologous transplantation were 10 months and 34%, not clearly different to the 10 months and 22% observed for the 35 patients treated with chemotherapy alone (P=0.67). Conclusions. CR rate after FLAG-IDA induction chemotherapy for patients with MDS is as high as that achieved with standard chemotherapy regimes in elderly patients with AML, but treatment-related toxicity remains a serious threat. Autologous stem cell transplantation did not provide any advantage in terms of EFS in comparison with chemotherapy alone in high risk MDS or sAML. These results in a homogeneous population of patients with MDS strongly disagree with those previously reported by the EBMT group.

scholarly journals Plasma Cell Disorders and Dialysis-Dependent Renal Failure: Safety and Efficacy of Autologous Stem Cell Transplantation

2018 ◽  
Vol 139 (2) ◽  
pp. 101-103 ◽  
Author(s):  
Francesca Martini ◽  
Gabriele Buda ◽  
Enrico Orciuolo ◽  
Sara Galimberti ◽  
Francesco Mazziotta ◽  
...  
Keyword(s):  
Renal Failure ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Plasma Cell ◽  
Safety And Efficacy ◽  
Plasma Cell Disorders
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