Bleeker, J.S.

Buadi, F.

Dingli, D.

Dispenzieri, A.

Gertz, M.A.

Hayman, S.R.

Hogan, W.

Kumar, S.

Lacy, M.Q.

Pellikka, P.A.

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Table 1.
Age
Nadir
wbc Nadir plt
Days to
wbc>1
Days to CD34>10,
median (quartiles)
Days between
wbc>1 to 34>10,
median (quartiles)
Good (n5370) 58 0.3 68 11 12 (11-13) 0 (0-1)
Poor (n526) 64 0.2 30 12 13 (13-16) 2 (2-3.5)
P value 0.003 0.07 0.02 0.03 0.01 0.0005
Optimal (n5340) 58 0.3 67 11 12 (11-13) 0 (0-1)
Suboptimal (n530) 65 0.3 83 12 14 (11.75-15) 1.5 (0.75-2)
P Value >0.05 0.3 0.5 0.1 0.0001 0.0001
Optimal <3apheresis (n5307) 58 0.3 67 11 11 (11-13) 0 (0-0)
Optimal >3 apheresis (n533) 59 0.4 80 12 14 (12-16.75) 2 (0-3.75)
P Value >0.05 0.2 0.9 0.2 0.0001 0.0001
Good: CD34+cells>2x106/kg, Poor: CD 34+ cells <2x106/kg, Optimal: CD34+cells >5x106/kg, Suboptimal: CD34+cells: 2-5x106/kg
Poster Session I S203factors for outcome CY-mob. If a higher CD341 cell count is tar-
geted for transplantation (. 5x106/kg), the delay in the days to
CD341 cells. 10 in peripheral blood can be considered to be a rea-
son formodifying themobilization regimen, like adding plerixafor. If
the CD34 count is still\ 10 one day after the day WBC . 1.0, ad-
dition of plerixafor to the mobilization regimen should be strongly
considered.134
AUTOLOGOUS STEM CELL TRANSPLANTATION IN MULTIPLE MYELOMA
IN THE ERA OF NOVEL AGENTS: IMPACT OF DEPTH OF RESPONSE TO IN-
DUCTION THERAPY. A SINGLE INSTITUTION EXPERIENCE
Tapia, M.G.1, Olarte, K.2, Mckinnon, R.1, Ruemenapp, K.1,
Janakiraman, N.1 1Henry Ford Hospital, Detroit, MI; 2Henry Ford Hos-
pital, Detroit, MI
Background: High-dose chemotherapy and autologous stem cell
transplantation (ASCT) in newly diagnosed multiple myeloma is
the standard of care for eligible patients. Prior to ASCT, induction
therapy is administered for 1 to 4 months before stem cell collection.
Eligible patients undergo ASCT regardless of the response to induc-
tion therapy because it has been shown that a good response is not
essential in order to obtain survival benefit from ASCT. A recent
study that evaluated the novel agents, thalidomide and lenalidomide
demonstrated that failure to achieve a partial response after induc-
tion therapy predicts a poorer outcome after ASCT.
Methods: Fifty patients (60% male; median age 59 years) with mul-
tiple myeloma who underwent high-dose chemotherapy and ASCT
after induction therapy with thalidomide, lenalidomide or bortezo-
mib were retrospectively studied. The patients were divided into
two groups according to their response after induction therapy:
those with CR or VGPR; and those with PR or less than PR. Statis-
tical analyses were performed.
Results:The median follow up was 33.4 (2.9-71.2) months. TheM-
protein at diagnosis was 3.46 1.7 g/dl and the stage (Durie-Salmon)
of the multiple myeloma was IIIa in 33 (66%) and IIIb in 9 (18%) pa-
tients. Beta-2 microglobulin was 4.96 4.7 g/ml and 40% of patients
had unfavorable cytogenetics defined as 13q- by cytogenetics, t
(4,14), t(14,16), 17p- and complex karyotype. Favorable cytogenetics
included normal, t(11,14) or 13q- by FISH. The induction therapy
was thalidomide in 23 (46%), lenalidomide in 9 (18%), bortezomib
in 8 (16%) and a combination in 10 (20%). The patients who
achievedCR orVGPR after induction therapywere 23 (46%). These
responses were associated with longer time to progression (HR 5
0.42; p5 0.055) after ASTC.The progression-free survival (PFS) es-
timates for CR or VGPR vs PR or\PR were 48.6 months and 21.5
months respectively (p 5 0.013). The presence of favorable cytoge-
netics was associated with a longer time to progression (HR5 0.345;
p5 0.0174). A higher beta-2 microglobulin was associated with ear-
lier time to progression (HR 5 1.073; p 5 0.0272).
Conclusion: Achieving CR or VGPR with the novel agents prior to
ASCT predicts a better PFS after transplantation. This suggests thatextending induction therapy to achieve CR or VGPR prior to ASCT
might be beneficial. Larger studies are needed to confim this finding.135
CARDIOMYOPATHY FOLLOWING HIGH DOSE MELPHALAN CONDITION-
ING PRIOR TO AUTOLOGOUS PERIPHERAL BLOOD STEM CELL TRANS-
PLANTATION FOR MULTIPLE MYELOMA AND PRIMARY AMYLOIDOSIS
Bleeker, J.S.1, Gertz, M.A.1, Pellikka, P.A.2, Buadi, F.1, Dingli, D.1,
Dispenzieri, A.1, Hayman, S.R.1, Hogan, W.1, Kumar, S.1,
Lacy, M.Q.1 1Mayo Clinic, Rochester, MN; 2Mayo Clinic, Rochester, MN
Background: High dose melphalan (HDM) is a commonly utilized
conditioning regimen prior to autologous peripheral blood stem cell
transplantation (PBSCT) for multiple myeloma and primary amy-
loidosis. Although cardiotoxicity from this regimen has not been de-
scribed, there are multiple anecdotal cases of transient
cardiomyopathy following HDM in the Mayo Clinic transplant ex-
perience. Thus, we reviewed our experience to determine the fre-
quency of cardiomyopathy in this setting.
Methods: From our database of all patients undergoing autologous
PBSCT for myeloma or amyloidosis from 1989-2009, we identified
those with echocardiograms performed before and within 4 months
of PBSCT, and reviewed these for evidence of cardiomyopathy, de-
fined as a decrease in left ventricular ejection fraction (LVEF) of $
10% to a value of # 50%. Charts of patients meeting these criteria
were reviewed to determine conditioning regimen, pre-existing car-
diac risk factors and other potential causes of cardiomyopathy to de-
termine the association between the cardiomyopathy and HDM.
Results:Of 1476 patients (1050 myeloma; 426 amyloidosis) who re-
ceived HDM as a component of conditioning prior to PBSCT, 407
had echocardiography before and within 4months after PBSCT, and
40 (2.7%) met criteria for cardiomyopathy. When accounting for
other risk factors, HDMwas felt to be a probable cause of cardiomy-
opathy in 16 patients, a possible cause in 18, and an unlikely cause in
6. Cardiomyopathy was noted more frequently in patients undergo-
ing PBSCT for amyloidosis (23/426, 5.4%) than myeloma (17/1050,
1.6%). All 23 patients with amyloidosis received HDM alone as con-
ditioning (dose range 140-200 mg/m2). Fifteen of the 17 myeloma
patients received HDM alone as conditioning (dose range 140-200
mg/m2), with two patients receiving HDM in concert with total
body irradiation and ibritumomab, respectively.
The mean pre-PBSCT LVEF in this cohort was 59% (range 42-
70%), which decreased to a mean of 38% (range 15-50%) following
PBSCT. Diagnosis of cardiomyopathy was made within 30 days of
PBSCT in 65% (26/40) of patients. Follow up echocardiography
was performed in 26 patients, with 15 showing improvement in
LVEF to $ 50%.
Conclusion: To our knowledge, this is the first series to report car-
diomyopathy following HDM conditioning. Further work should
focus on identifying pre-transplant variables which may predispose
patients to cardiotoxicity following conditioning with HDM.


Cardiomyopathy Following High Dose Melphalan Conditioning Prior to Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma and Primary Amyloidosis 

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Cardiomyopathy Following High Dose Melphalan Conditioning Prior to Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma and Primary Amyloidosis

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