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KMID : 0338420110260010076
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The Korean Journal of Internal Medicine
2011 Volume.26 No. 1 p.76 ~ p.81
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Predictive Value of Post-Transplant Bone Marrow Plasma Cell Percent in Multiple Myeloma Patients Undergone Autologous Transplantation
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Hwang In-Hye
Chung Joo-Seop
Shin Ho-Jin
Choi Young-Jin
Song Moo-Kon
Seol Young-Mi
Cho Goon-Jae
Choi Bo-Gwang
Choi Mun-Ki
Choi Bo-Kyung
Ahn Kang-Hee
Shin Kyung-Hwa
Lee Hee-Sun
Nam Hyung-Seok
Hwang Jong-Min
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Abstract
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Background/Aims: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients
with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment.
Methods: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients
received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following
high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (≥ 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (≥ 50 vs. < 50%) on progressionfree survival (PFS) and overall survival (OS).
Results: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months,
respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp ≥ 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp ≥ 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp ≥ 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters.
Conclusions: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM
receiving ASCT.
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KEYWORD
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Multiple myeloma, Stem cell transplantation, Bone marrow, Plasma cell
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