Declining early mortality in stem cell transplantation for multiple myeloma

Morie Gertz, Martha Lacy, Angela Dispenzieri, D. A. Gastineau, D. J. Inwards, Ayalew Tefferi, M. Chen, Mark R Litzow

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Abstract

INTRODUCTION: Peripheral blood stem cell transplantation is being increasingly applied as initial therapy for the management of patients with multiple myeloma. Treatment related mortality is a threat to the utility of this approach. Deaths following conventional induction chemotherapy are uncommon. We report on early mortality associated with stem cell transplantation over three time periods between 1989 and the present. MATERIALS AND METHODS: All 165 patients transplanted between 1989 and April 1. 2000 are included. Patients with variants such as solitary plasmacytoma or osteosclerotic myeloma were excluded. Mobilization consisted of Cyclophosphamide 1.5 g/m2 daily x 2 days followed by GM-CSF 5 mcg/kg/day subcutaneously until the completion of stem cell collection. The patients were required to have a performance status between 0 and 3 and a creatinine less than 3 mg/dL. Patients were conditioned with a TBI-containing regimen (126) or chemotherapy alone (39). RESULTS: Seven of 30 patients (23%) transplanted prior to 1994 died prior to day 100. Two succumbed day +12 and day +49 to infectious complications while neutropenic. One died of E. coli bacteremia on day -1. One died of veno-occlusive disease on day +24. One developed an aspergillus infection related to high dose corticosteroids for relapsed disease on day +56. One patient died day +23 with CMV pneumonitis and one had an intracerebral bleed day +93 with a platelet count of 1,000/iiL. Between 1994 and 1996, 4 of 38 (11%) died prior to day 100. One patient committed suicide on day +58, one patient succumbed to veno-occlusive disease on day +47, one patient from rapid relapse of plasma cell leukemia on day +46 and a fourth patient with refractory plasma cell leukemia died on day +28 from septic shock. After 1996 there was one early death of 97 transplanted patients. This patient died on day +100 of acute respiratory distress syndrome with respiratory failure. No organism was recovered. There was no statistical difference between the early mortality patients and the rest of the transplanted group by age, gender, creatinine, beta 2 microglobulin, bone marrow labeling index, presence of any chromosome abnormality or disease status at the time of transplantation (i.e. sensitive or resistant) (P > 0.1 ). CONCLUSION: At our institution, the incidence of early death after autologous stem cell transplantation for myeloma has decreased in recent years. Possible contributing factors for this include careful patient selection, the use of less toxic conditioning regimens, improved technology for assessing the stem cell content of the harvest product, and ongoing progress in supportive care. In appropriately selected patients with multiple myeloma, current mortality rates associated with autologous stem cell transplant should be less than 3%.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART II
StatePublished - 2000

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Stem Cell Transplantation
Stem cells
Multiple Myeloma
Mortality
Chemotherapy
Creatinine
Plasmas
beta 2-Microglobulin
Transplants
Plasma Cell Leukemia
Aspergillus
Poisons
Granulocyte-Macrophage Colony-Stimulating Factor
Chromosomes
Platelets
Stem Cells
Refractory materials
Cyclophosphamide
Labeling
Escherichia coli

ASJC Scopus subject areas

  • Hematology

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Declining early mortality in stem cell transplantation for multiple myeloma. / Gertz, Morie; Lacy, Martha; Dispenzieri, Angela; Gastineau, D. A.; Inwards, D. J.; Tefferi, Ayalew; Chen, M.; Litzow, Mark R.

In: Blood, Vol. 96, No. 11 PART II, 2000.

Research output: Contribution to journalArticle

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title = "Declining early mortality in stem cell transplantation for multiple myeloma",
abstract = "INTRODUCTION: Peripheral blood stem cell transplantation is being increasingly applied as initial therapy for the management of patients with multiple myeloma. Treatment related mortality is a threat to the utility of this approach. Deaths following conventional induction chemotherapy are uncommon. We report on early mortality associated with stem cell transplantation over three time periods between 1989 and the present. MATERIALS AND METHODS: All 165 patients transplanted between 1989 and April 1. 2000 are included. Patients with variants such as solitary plasmacytoma or osteosclerotic myeloma were excluded. Mobilization consisted of Cyclophosphamide 1.5 g/m2 daily x 2 days followed by GM-CSF 5 mcg/kg/day subcutaneously until the completion of stem cell collection. The patients were required to have a performance status between 0 and 3 and a creatinine less than 3 mg/dL. Patients were conditioned with a TBI-containing regimen (126) or chemotherapy alone (39). RESULTS: Seven of 30 patients (23{\%}) transplanted prior to 1994 died prior to day 100. Two succumbed day +12 and day +49 to infectious complications while neutropenic. One died of E. coli bacteremia on day -1. One died of veno-occlusive disease on day +24. One developed an aspergillus infection related to high dose corticosteroids for relapsed disease on day +56. One patient died day +23 with CMV pneumonitis and one had an intracerebral bleed day +93 with a platelet count of 1,000/iiL. Between 1994 and 1996, 4 of 38 (11{\%}) died prior to day 100. One patient committed suicide on day +58, one patient succumbed to veno-occlusive disease on day +47, one patient from rapid relapse of plasma cell leukemia on day +46 and a fourth patient with refractory plasma cell leukemia died on day +28 from septic shock. After 1996 there was one early death of 97 transplanted patients. This patient died on day +100 of acute respiratory distress syndrome with respiratory failure. No organism was recovered. There was no statistical difference between the early mortality patients and the rest of the transplanted group by age, gender, creatinine, beta 2 microglobulin, bone marrow labeling index, presence of any chromosome abnormality or disease status at the time of transplantation (i.e. sensitive or resistant) (P > 0.1 ). CONCLUSION: At our institution, the incidence of early death after autologous stem cell transplantation for myeloma has decreased in recent years. Possible contributing factors for this include careful patient selection, the use of less toxic conditioning regimens, improved technology for assessing the stem cell content of the harvest product, and ongoing progress in supportive care. In appropriately selected patients with multiple myeloma, current mortality rates associated with autologous stem cell transplant should be less than 3{\%}.",
author = "Morie Gertz and Martha Lacy and Angela Dispenzieri and Gastineau, {D. A.} and Inwards, {D. J.} and Ayalew Tefferi and M. Chen and Litzow, {Mark R}",
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T1 - Declining early mortality in stem cell transplantation for multiple myeloma

AU - Gertz, Morie

AU - Lacy, Martha

AU - Dispenzieri, Angela

AU - Gastineau, D. A.

AU - Inwards, D. J.

AU - Tefferi, Ayalew

AU - Chen, M.

AU - Litzow, Mark R

PY - 2000

Y1 - 2000

N2 - INTRODUCTION: Peripheral blood stem cell transplantation is being increasingly applied as initial therapy for the management of patients with multiple myeloma. Treatment related mortality is a threat to the utility of this approach. Deaths following conventional induction chemotherapy are uncommon. We report on early mortality associated with stem cell transplantation over three time periods between 1989 and the present. MATERIALS AND METHODS: All 165 patients transplanted between 1989 and April 1. 2000 are included. Patients with variants such as solitary plasmacytoma or osteosclerotic myeloma were excluded. Mobilization consisted of Cyclophosphamide 1.5 g/m2 daily x 2 days followed by GM-CSF 5 mcg/kg/day subcutaneously until the completion of stem cell collection. The patients were required to have a performance status between 0 and 3 and a creatinine less than 3 mg/dL. Patients were conditioned with a TBI-containing regimen (126) or chemotherapy alone (39). RESULTS: Seven of 30 patients (23%) transplanted prior to 1994 died prior to day 100. Two succumbed day +12 and day +49 to infectious complications while neutropenic. One died of E. coli bacteremia on day -1. One died of veno-occlusive disease on day +24. One developed an aspergillus infection related to high dose corticosteroids for relapsed disease on day +56. One patient died day +23 with CMV pneumonitis and one had an intracerebral bleed day +93 with a platelet count of 1,000/iiL. Between 1994 and 1996, 4 of 38 (11%) died prior to day 100. One patient committed suicide on day +58, one patient succumbed to veno-occlusive disease on day +47, one patient from rapid relapse of plasma cell leukemia on day +46 and a fourth patient with refractory plasma cell leukemia died on day +28 from septic shock. After 1996 there was one early death of 97 transplanted patients. This patient died on day +100 of acute respiratory distress syndrome with respiratory failure. No organism was recovered. There was no statistical difference between the early mortality patients and the rest of the transplanted group by age, gender, creatinine, beta 2 microglobulin, bone marrow labeling index, presence of any chromosome abnormality or disease status at the time of transplantation (i.e. sensitive or resistant) (P > 0.1 ). CONCLUSION: At our institution, the incidence of early death after autologous stem cell transplantation for myeloma has decreased in recent years. Possible contributing factors for this include careful patient selection, the use of less toxic conditioning regimens, improved technology for assessing the stem cell content of the harvest product, and ongoing progress in supportive care. In appropriately selected patients with multiple myeloma, current mortality rates associated with autologous stem cell transplant should be less than 3%.

AB - INTRODUCTION: Peripheral blood stem cell transplantation is being increasingly applied as initial therapy for the management of patients with multiple myeloma. Treatment related mortality is a threat to the utility of this approach. Deaths following conventional induction chemotherapy are uncommon. We report on early mortality associated with stem cell transplantation over three time periods between 1989 and the present. MATERIALS AND METHODS: All 165 patients transplanted between 1989 and April 1. 2000 are included. Patients with variants such as solitary plasmacytoma or osteosclerotic myeloma were excluded. Mobilization consisted of Cyclophosphamide 1.5 g/m2 daily x 2 days followed by GM-CSF 5 mcg/kg/day subcutaneously until the completion of stem cell collection. The patients were required to have a performance status between 0 and 3 and a creatinine less than 3 mg/dL. Patients were conditioned with a TBI-containing regimen (126) or chemotherapy alone (39). RESULTS: Seven of 30 patients (23%) transplanted prior to 1994 died prior to day 100. Two succumbed day +12 and day +49 to infectious complications while neutropenic. One died of E. coli bacteremia on day -1. One died of veno-occlusive disease on day +24. One developed an aspergillus infection related to high dose corticosteroids for relapsed disease on day +56. One patient died day +23 with CMV pneumonitis and one had an intracerebral bleed day +93 with a platelet count of 1,000/iiL. Between 1994 and 1996, 4 of 38 (11%) died prior to day 100. One patient committed suicide on day +58, one patient succumbed to veno-occlusive disease on day +47, one patient from rapid relapse of plasma cell leukemia on day +46 and a fourth patient with refractory plasma cell leukemia died on day +28 from septic shock. After 1996 there was one early death of 97 transplanted patients. This patient died on day +100 of acute respiratory distress syndrome with respiratory failure. No organism was recovered. There was no statistical difference between the early mortality patients and the rest of the transplanted group by age, gender, creatinine, beta 2 microglobulin, bone marrow labeling index, presence of any chromosome abnormality or disease status at the time of transplantation (i.e. sensitive or resistant) (P > 0.1 ). CONCLUSION: At our institution, the incidence of early death after autologous stem cell transplantation for myeloma has decreased in recent years. Possible contributing factors for this include careful patient selection, the use of less toxic conditioning regimens, improved technology for assessing the stem cell content of the harvest product, and ongoing progress in supportive care. In appropriately selected patients with multiple myeloma, current mortality rates associated with autologous stem cell transplant should be less than 3%.

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