Autologous Hematopoietic Progenitor Cell Transplant in Patients with Multiple Myeloma in Hospital Central Sur De Alta Especialidad in Petróleos Mexicanos

INTRODUCTION

Multiple Myeloma (MM) is a clonal B cells disorder producing an accumulation of plasmatic abnormal cells and abnormal light or heavy immunoglobulines. The onset of multiple myeloma is usually insidious, and the subclinical phase may vary in duration from 1 to 3 years. Bone pain is the most frequent initial feature and 60% of patients present with this symptom. Other clinical features may result from anaemia, uraemia, hypercalcaemia, infections, paraplegia, hyperviscosity syndrome and sensorimotor peripheral neuropathies. It accounts for approximately 1% of all neoplastic diseases and 10% of haematological malignancies. The sex incidence of myeloma is approximately equal until the age of 65 years, after which it is somewhat more common in men than in women. The incidence is approximately 3.8 per 100,000 population, it is lower in the white than the black population. In the last decades different treatments have been described with 60 to 80% of complete response, nevertheless disease free survival rate goes from 22 to 50% in the best treatment international centers. That is why autologous transplantation has been used in patients below 65 years old with very good response.

OBJECTIVE

Describe the experience of patients treated with autologous hematopoietic progenitor cell transplant with diagnosis of Multiple Myeloma in Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos (PEMEX).

MATERIAL AND METHODS

We analyzed clinical data of patients with diagnosis of Multiple Myeloma that were transplanted from april 2008 to may 2014.

RESULTS

Ten patients were studied, three of them were over 65 years. Only 7 patients were considered for autologous hematopoietic progenitor cell transplantation, there ages were from 40 to 55 years with a median of 46 years. Transplants were performed from april 2008 to may 2014, 66% were men and 34% women. 66% were IgG and 18% IgA. Presence of Bence-Jones protein without monoclonal peak was found in 16% of the patients. In regard to prognosis index 66% were ISS-I and 34% were ISS-I. Cytogenetic studies were not performed because we did not have molecular cytogenetics so we could not perform the usual FISH translocations described in this disease.

One hundred percent of the patients received the first line treatment with dexamethasone, cyclophosphamide, thalidomide and bortezomib. Only one patient received radiotherapy because he had a tumor in the leg, before the transplant was done 68% had complete response and 16 % partial response.

Six autologous transplants were doned with conditioning by giving melphalan 200 mg/m2 orally because we did not have IV presentation. The 7 transplanted patients are alive and 71% had complete response and 29% had partial response. Patients that were transplanted responded 11 or 12 days after the transplant.

CONCLUSIONS

Patients with multiple myeloma that were transplanted were below 46 years, there were below the age reported in the literature, the predominant gender was masculine (2:1). The majority was IgG.

The overall survival after the transplant was 40 months (72-6), the most common complication associated to transplant was fever and neutropenia and only in 16% of the patients we could isolate the germ.

The patients are currently alive and in complete remission until june 2014.

We think that this is the most adequate actual treatment for patients with Multiple Myeloma. We found in the literature that lenalidomide, carfilzomib and dexamethasone may achieve the same response that autologous hematopoietic cell transplant but the results are still in intense investigation.