High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Multiple Myeloma: A Single Institution Experience at All India Institute of Medical Sciences, New Delhi, Using Non-Cryopreserved Peripheral Blood Stem Cells

作者：Kayal Smita; Sharma Atul; Iqbal Sobuhi; Tejomurtula Tilak; Cyriac Sunu L; Raina Vinod^*

来源：Clinical Lymphoma Myeloma & Leukemia, 2014, 14(2): 140-147.

DOI：10.1016/j.dml.2013.09.001

• Autotransplant
• High-dose melphalan
• India
• Myeloma
• Unfrozen stem cells

High-dose chemotherapy and autologous transplant is central to treatment of multiple myeloma (MM). To make this treatment modality possible at centers with limited resources, we highlight the use of non-cryopreserved peripheral blood stem cells (PBSC), stored at 4 C in a refrigerator, and report our results in 92 patients, which are equivalent to that of transplants with cryopreserved stem cells.
Background: Intravenous high-dose melphalan has a short half-life, and application of this single drug in MM transplant favors the use of stem cells without cryopreservation, for wider use in general and in resource-limited settings in particular. Patients and Methods: Ninety-two patients with MM were given high-dose melphalan and rescued with granulocyte colony stimulating factor (G-CSF) mobilized noncryopreserved autologous PBSC, in our hospital during the past 18 years. Stem cells were mobilized with 4 days of G-CSF, harvested (median CD34 dose, 2.9 x 10(6)/kg) and then stored at 4 degrees C in a refrigerator for a median of 2 days (range, 1-5 days) before reinfusion. Results: Median time to neutrophil (> 500/mm(3)) and platelet (> 20,000/mm(3)) engraftment were 10 and 14 days respectively. There was no graft failure. Mucositis grade 3/4 was seen in 66 patients (72%). Transplant-related mortality at 100 days was 3.2%. The overall response to transplant was 88% and improvement compared with pretransplant status was seen in 48%. The median overall survival (OS) and progression-free survival (PFS) were 61.7 months and 35.4 months respectively; independent predictors of survival were Eastern Cooperative Oncology Group Performance Status and hemoglobin for OS and chemosensitive disease and remission status after transplant for PFS. Conclusion: We conclude that high-dose chemotherapy and autologous transplant with noncryopreserved PBSC is a simple, effective, and safe method for MM with equivalent results, and that cryopreservation is not necessary. It reduces the cost of transplant and avoids dimethyl sulfoxide toxicity.

• 出版日期2014-4
• 单位河北医科大学