Evaluating the Effect of High Dose Chemotherapy and Autologous Bone Marrow Transplantation (ASCT) On Hypertension (HTN) in Multiple Myeloma (MM) Patients

1. Background

A recent study showed that ASCT may reverse kidney failure in one third of multiple myeloma patients, which can lead to improvement in blood pressure. However, there is very limited published data studying the impact of the treatment on blood pressure control.

2. Methods

We conducted a review of electronic medical records of 184 patients with established diagnosis of MM that underwent an ASCT at Karmanos Cancer Institute between January 1^st, 2009 and December 31^st, 2010. We recorded data that includes blood pressure (BP) readings 4 weeks before the transplant and then at days 0, 30, 100 and 180. Other data includes GFR which is calculated by using the Cockcroft Gault formula at the same intervals, sub-type of MM and Durie-Salmon stage at diagnosis, disease response to therapy, BMI at baseline; and other comorbidities such as diabetes, hyperlipedemia and coronary artery disease. Statistical analyses were performed using the statistical package of SPSS version 18. All P values were 2-sided.

3. Results

In this study 184 patients were included. The sample demographics at baseline are presented in Table 1.  Association between BP stages  and disease status before ASCT and  at day 0 was statistically significant ( p=.025 , X²  =14.408); there was no statistically significant  association between  stages of HTN at   0 , 30, 100 and 180 days after the ASCT  in regards  to  age , race or gender. Mean Systolic and diastolic BP value showed no statistically significant difference at the same intervals respectively. In addition, there was no correlation between stages of HTN, and stages or type of MM. The only statistically significant association between chronic kidney disease (CKD) stages and BP stages was at day 0 (day ASCT infused) (P=.032, X^{2 =}26.670. The association between CKD stages and disease status at 100 days after melphalan was statistically significant (P=.043, X² =25.568).  The associations between BP stages and BMI stages were borderline or statistically significant at 30 days(P=.054 and  X²  =16.665), 100 days( P=.026 and X²  =18.947)  and 180 days( P=.001, X²  =27.120).

Conclusion:

There was no direct effect of ASCT on blood pressure improvement. Other factors such as BMI and disease status at baseline appear to play more roles on Bp control. Majority of our patient were transplanted at early stages of (CKD) which can explain the result. We suggest a prospective study that evaluates the impact of ASCT in MM patients with high BP