Early mortality, kidney failure, and venous thromboembolism in patients with multiple myeloma: a single-center analysis

Introduction: The objectives were to assess early mortality, the prevalence of kidney failure, venous thromboembolism (VTE), and to assess overall survival (OS) in patients with multiple myeloma (MM). Material and methods: A retrospective analysis of clinical and laboratory parameters in 413 patients with MM treated between 2006 and 2017. Results: The early mortality rate in the study group was 13% (57 of the 413 patients). Mortality rates were higher in men [odds ratio (OR) = 1.4] (p = 0.015), patients with kidney failure (OR = 9.1) (p = 0.001), and patients with significant proteinuria and immunoglobulin A secretion (OR = 1.3). Early mortality was not associated with age, lactate dehydrogenase levels, or hemoglobin levels at diagnosis. Patients with kidney failure at diagnosis of MM had lower total protein levels (p <0.001) and higher proteinuria levels (p <0.001) than the remaining patients. The 5-year OS in patients with kidney failure was 20% vs. 50% in those without kidney failure (p  0.001). VTE was reported in 38 patients (10.7%). There was no association between VTE and the patient’s age, kidney failure, urinary protein levels, type of monoclonal protein, stage of MM according to the International Staging System, or type of induction therapy. The median OS in the study group was 4.08 years. There was no correlation between VTE and OS in patients undergoing autologous hematopoietic stem cell transplantation. Conclusions: The use of novel drugs with a different mechanism of action in the treatment of MM has led to an improvement in survival rates, with an increase in median OS from 3–4 years to 5–7 years over the past 10 years. Still, it is estimated that 25% of patients die within less than 2 years from diagnosis

High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation : a report of the Polish Myeloma Study Group

The present retrospective analysis evaluated the efficacy and safety of the VTD (bortezomib, thalidomide, dexamethasone) regimen in 205 newly‑diagnosed patients with multiple myeloma (MM) eligible for high dose therapy and autologous stem cell transplantation (HDT/ASCT) in routine clinical practice. With a median of 6 cycles (range, 1‑8), at least partial response was achieved in 94.6% and at least very good partial response (VGPR) was achieved in 67.8% of patients. Peripheral neuropathy (PN) grade 2‑4 was observed in 28.7% of patients. In 72% of patients undergoing stem cell mobilization one apheresis allowed the number of stem cells sufficient for transplantation to be obtained. Following HDT/ASCT the sCR rate increased from 4.9 to 14.4% and CR from 27.8 to 35.6%. The results demonstrated that VTD as an induction regimen was highly efficient in transplant eligible patients with MM with increased at least VGPR rate following prolonged treatment (≥6 cycles). Therapy exhibited no negative impact on stem cell collection, neutrophils and platelets engraftment following ASCT. Therapy was generally well tolerated and PN was the most common reason of dose reduction or treatment discontinuation

Survival in patients with multiple myeloma: a real-life single-center study

Introduction: The development of novel drugs with a different mechanism of action has led to considerable progress in multiple myeloma (MM) treatment. However, the exact associations between overall survival (OS) and different treatment types, response to treatment, as well as clinical and laboratory parameters, have not been fully elucidated. We aimed to determine the effect of clinical and laboratory parameters, type of induction therapy, and high-dose chemotherapy with autologous hematopoietic stem-cell transplant (auto-HSCT) on OS in patients with MM. Material and methods: This retrospective study included 413 patients with MM treated between 2006 to 2017. Correlations between selected clinical and laboratory parameters and OS were assessed. The severity of MM was evaluated using the Durie-Salmon classification. Results: The median OS was 4.08 years. The overall response rate to chemotherapy was 76%. The complete remission (CR) rates were higher in patients receiving bortezomib-based therapy than in those receiving thalidomide-based therapy or standard chemotherapy (p < 0.001). The CR rate was positively correlated with OS. The use of auto-HSCT with bortezomib-based therapy was associated with longer OS. Renal failure and elevated urinary protein levels were inversely correlated with OS. The severity of MM at diagnosis was also associated with OS. The percentage of bone marrow  plasma cell infiltration did not correlate with OS. Conclusions: MM is still diagnosed too late, by which time patients have developed almost irreversible complications. However, we confirmed that novel treatments improve OS in these patients, especially when used in addition to auto-HSCT. These findings may facilitate clinical therapeutic decision making

Prognostic indicators in primary plasma cell leukaemia: a multicentre retrospective study of 117 patients

We report a multicentre retrospective study that analysed clinical characteristics and outcomes in 117 patients with primary plasma cell leukaemia (pPCL) treated at the participating institutions between January 2006 and December 2016. The median age at the time of pPCL diagnosis was 61 years. Ninety-eight patients were treated with novel agents, with an overall response rate of 78%. Fifty-five patients (64%) patients underwent upfront autologous stem cell transplantation (ASCT). The median follow-up time was 50 months (95% confidence interval [CI] 33; 76), with a median overall survival (OS) for the entire group of 23 months (95% CI 15; 34). The median OS time in patients who underwent upfront ASCT was 35 months (95% CI 24·3; 46) as compared to 13 months (95% CI 6·3; 35·8) in patients who did not receive ASCT (P = 0·001). Multivariate analyses identified age ≥60 years, platelet count ≤100 × 109 /l and peripheral blood plasma cell count ≥20 × 109 /l as independent predictors of worse survival. The median OS in patients with 0, 1 or 2-3 of these risk factors was 46, 27 and 12 months, respectively (P < 0·001). Our findings support the use of novel agents and ASCT as frontline treatment in patients with pPCL. The constructed prognostic score should be independently validated. © 2018 John Wiley & Sons Lt