>Revista de Hematología
>Year 2015, Issue 3
Alvarado-Ibarra M, Ramos-León EM, López-Hernández M, Ortiz-Zepeda SM, Álvarez-Vera JL
Survival free of progression and overall survival in patients with multiple myeloma submitted to autologous hematopoietic stem cells transplantation with schemes of conditioning alternative to endovenous melphalan
Rev Hematol Mex 2015; 16 (3)
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Background: Results in patients with multiple myeloma submitted to
autologous hematopoietic stem pluripotential cells transplantation
with conditioning with endovenous melphalan is widely documented;
however, due to the endovenous presentation is not available in our
media, it is necessary to know the results of alternative schemes about
overall survival and survival free of progression.
Objective: To know the overall survival and survival free of progression
in patients with multiple myeloma submitted to autologous hematopoietic
stem pluripotential cells transplantation with alternative schemes
to endovenous melphalan attended at Hematology Service of National
Medical Center 20 de Noviembre, Mexico City.
Patients and method: An observational, descriptive, cross-sectional,
comparative, retrospective and retrolective study including patients
18-65 years old with diagnosis of multiple myeloma included in the
program of autologous hematopoietic stem pluripotential cells transplantation
and submitted to the procedure at Hematology Service of
National Medical Center 20 de Noviembre, Mexico City from January
2000 to May 2014.
Results: 36 patients with multiple myeloma included in the program
of autologous hematopoietic stem pluripotential cells transplantation
were assessed. Mean time since diagnosis to transplantation was of 15.5
months (6-39 months); 58% received schemes of conditioning based
on oral melphalan and 42%, based on busulphan. Myeloid graft was
earlier (mean: 12 days) in group melphalan (p=0.04). Progression was
observed in 7 days (2 in group melphalan and 5 in group busulphan). All
mortality related to transplantation occurred in the group of busulphan
(p=0.002). Survival free of progression was not reached in group of
melphalan, while in group of busulphan it was of 96 months (p=0.77).
Mean overall survival in group of melphalan was not reached, while in
group of busulphan it was of 106 months (p .016). Toxicity was higher
in group of busulphan in combined schemes with etoposide with severe
mucositis in 55% of cases.
Conclusions: Despite of endovenous melphalan is to date the standard
treatment preferred for conditioning in autologous hematopoietic stem
pluripotential cells transplantation in patients with multiple myeloma,
administration of oral melphalan offers encouraging results because at
a follow-up of 55 months, only two progressions were documented at
12 and 27 months in our population; however, it is necessary a higher
time of follow-up to generate solid conclusions. Despite the high toxicity
observed in the group of busulphan, there was a significant difference
about overall survival. Mortality related to treatment in our service is
comparable to the results informed in literature. There was not found
relation among variables studied and progression of the disease. Time
between diagnosis and transplantation neither had effect.
||multiple myeloma, autologous transplantation, melphalan, conditioning.
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>Revista de Hematología
>Year 2015, Issue 3