The Impact of Co-Morbidities on the Outcome of Autologous Stem Cell Transplantation for Multiple Myeloma

Autologous stem cell transplantation (ASCT) is used as an upfront and salvage therapy for multiple myeloma (MM). We assessed the prognostic value of pre-transplant co-morbidity on the transplant outcome.

We analyzed the data of 162 patients with MM who underwent single ASCT between 2004 and 2009 in our center. Pre-transplant co-morbidity was scored according to the hematopoietic cell transplant co-morbidity index (HCT-CI). Data were tabulated and statistical difference was calculated using t-test and Chi square test. Correlation coefficiency test was used to correlate HCI-CI with data of continuous variables. Probabilities of overall survival were analyzed using Kaplan-Meier analysis.

The median follow up after transplant was 23 months (range: 0.7–78). The median age at transplant was 60 years (range: 34–77), males were 64%. A total of 130 patients (80%) had transplant at ≤ 12 months from diagnosis. The proportion of IgG, IgA and free light chain subtypes was 54, 24 and 17% respectively. Durie Salmon stage at diagnosis was stage I (8%), II (12%), III (60%) respectively. The median HCT-CI was 2 (range: 0–8). HCT-CI was 0, 1–2, >2 in 27%, 32%, and 41% respectively. There was no significant correlation between HCT-CI and time to engraft or length of stay. Patients with HCT-CI of 0–2 (group 1; n= 95) and >2 (group 2; n=67) had a re-admission rate (within 30 days) of 13.7% and 21% respectively (p=0.23). Group 1 had non-relapse mortality (NRM) of 0% at 18 months, while group 2 had NRM of 2% and 2.5% at 6 months and 18 months respectively (p= 0.02). There was no significant difference in the OS; not reached and 60 months in group 1 and 2 respectively (p=0.3).

These data show that high pre-transplant HCT-CI is associated with higher NRM following ASCT for multiple myeloma. This finding needs to be validated in a large cohort of patients.

No relevant conflicts of interest to declare.