263 Outcomes of Second Autologous Stem Cell Transplant in Patients with Renal Dysfunction

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Lakshminarayanan Nandagopal, MD , Department of hematology and medical oncology, karmanos cancer intitute, detroit, MI
Christine Ye, MD , department of hematology and medical oncology, Karmanos cancer intitute, detroit, MI
Muneer H. Abidi, MD , Karmanos Cancer Institute/ Wayne State University, Detroit, MI
Lois Jeanne Ayash, MD , Karmanos Cancer Institute/ Wayne State University, Detroit, MI
Richard Manasa , Karmanos Cancer Institute - Wayne State Univ, Detroit, MI
Lawrence Lum, MD, DSc , Oncology, Karmanos Cancer Institute, Detroit, MI
Joseph Uberti, MD , Karmanos Cancer Institute/ Wayne State University, Detroit, MI
Voravit Ratanatharathorn, MD , Karmanos Cancer Institute/ Wayne State University, Detroit, MI
Jeffrey Zonder, MD , Department of hematology and medical oncology, Karmanos cancer intitute, Detroit, MI
Divaya Bhutani, MD , Oncology, Karmanos Cancer Institute, Detroit, MI
Abhinav Deol, MD , Karmanos Cancer Institute/ Wayne State University, Detroit, MI
Presentation recording not available for download or distribution as requested by the presenting author.

Second autologous stem cell transplant (ASCT) is a treatment option for multiple myeloma (MM) patients (pts) who have disease progression after first ASCT.  Outcomes of second ASCT in pts with renal dysfunction (RD) have not been described. 

 We identified 18 pts at our institution who underwent a second ASCT for relapsed MM and had evidence of RD (creatinine clearance ≤ 60ml/min/1.73m2). Pts who underwent a planned tandem transplant were excluded from this analysis. Patient characteristics are shown in Table 1. Ten pts received one chemotherapy (CT) regimen while nine pts received two or more CT regimens between first and second ASCT. The CT regimens used between first and second transplant included Imid based (n=6), proteosome inhibitor based (n=3) and combination of both (n=9). Approximately half of the pts had progressive disease at the time of second ASCT. Median creatinine clearance at the time of second ASCT was 43.5 ml/min/1.73m2. One pt was dialysis dependent. All pts received G-CSF 5µg/Kg from day + 6 till ANC was ≥1500/ µL.

Median follow up post second ASCT was 17.1 months (range, 2.4- 100). One pt died at day 74 due to multi organ failure. Of 17 evaluable pts at day 100, twelve had an upgrade from the disease response category achieved with the last regimen used prior to second ASCT while five pts had stable disease response. Three pts received maintenance therapy after the second ASCT with bortezomib(n=2) and lenalidomide (n=1). Figure 1 shows the overall survival (OS) after second ASCT and Figure 2 shows the relapse free survival (RFS) of from first and second ASCT.  After the second ASCT, the median OS was 27 months while the median RFS was 22.2 months (median RFS after first ASCT was 24 months).

The transplant related mortality of these pts was not higher than expected and the median RFS of about 2 years makes the option of second ASCT in this group of patients a valuable treatment modality and is comparable to reported outcomes after second ASCT.  In addition, the RFS after second ASCT was similar to the first ASCT in our experience. The utility of maintenance therapy after the second ASCT is not established, but may have contributed to the durable responses seen in some pts assessed herein and deserves to be investigated further. 

  Table 1: Pt Characteristics

Patient Characteristics

N (%)

Median Age (range)

61 years(49-72)

Median Time from First ASCT (range)

49.8 months(19.2-81.9)

Race

Caucasians

13 (72%)

Others

5 (28%)

Disease status at time of ASCT

PD

9 (50%)

SD

5 (28%)

PR

1 (5.5 %)

VGPR

2 (11%)

CR

1 (5.5%)

Median creatinine clearance (range)

43.5 (5-59)

Cytogenetic Risk

Standard

10 (56%)

High Risk

4(22%)

Unknown

4 (22%)

Melphalan Dose median mg/m2( range)

140 (100-200)

 {100(2pts), 140(10pts), 180(1pt), 200(4pts)}

Median CD 34 Cell dose x106/kg (range)

4.66(2.6-27.5)

Median Engraftment Day (range)

WBC

11 (9-16)

Platelets

21 (12-61)

Median Days of Hospitalization

(range)

19 (11-74)

      

Disclosures:
M. H. Abidi, Seattle Genetics, Inc., study investigator: Research Funding and Speakers Bureau

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