- Email: [email protected]
Secondary Malignancies in Multiple Myeloma
Abstracts PO-204
early identification of patients at increased risk is of great importance for modifying treatment to minimize this risk.
Secondary Malignancies in Multiple Myeloma C. Vadikoliou,1 D. Malouri,1 M. Kaliou,1 Z. Bousiou,1 C. Lalayianni,1 A. Athanasiadou,1 E. Spanoudakis,2 K. Kokoviadou,3 I. Katodritou,4 V. Garypidou,5 G. Kiriazis,6 R. Saloum,1 I. Sakellari,1 A. Anagnostopoulos1 1
Haematology and Bone Marrow Transplantation Dpt, G. Papanikolaou Hospital Thessaloniki, Thessaloniki, Greece; 2Haematology Dpt.
PO-205 Autologous HCT in Elderly Myeloma Patients, AHNCI Single Institution Experience
of Democritus Univercity of Thrace, Thessaloniki, Greece; 3Haema-
E. Sahovic, N. Patel, S. Sadashiv, J. DeYao, G. Berteotti, J. Lister
tology Dpt Papageorgiou Hospital, Thessaloniki, Greece; 4Haema-
Allegheny Health Network Cancer Institute
tology Dpt Theagenio Hospital, Thessaloniki, Greece; 5Dpt. Of Internal medicine, AUTH, Hippokration Hospital, Immunology Lab., Thessaloniki, Greece; 6Pneumonology Dpt AUTH. G.Papanikolaou Hospital, Thessaloniki, Greece
Introduction/Background: A tremendous progress has been achieved in the era of multiple myeloma (MM) treatment with the emerge of novel agents. The number of long-term survivors is continuously rising and the risk of secondary malignancies is of great importance. Based on a restricted number of studies, prior treatment is considered the main risk factor for second malignancies. Chromosome 7 or 5 deletions are typical of alkylating agents’ related t-AML/MDS with an estimated risk of 1% -1.5% per year 2-10 years after the exposion. Radiotherapy is also a well-established risk factor for secondary malignancies. Materials and Methods: In this retrospective study, we evaluated the frequency of secondary malignancies, t-AML/MDS, solid tumors following chemotherapy/ radiotherapy or autologous haematopoietic cell transplantation (AHCT) in a cohort of 360 consecutive patients (pts) with a diagnosis of MM over a period of twenty years (1988-2015). Results: All patients (360) were treated with more than two lines of chemotherapy including alkylating agents. Primary treatment was :VAD in 114, Bortezomib-based in 94 and radiotherapy in 56 pts. One hundred sixty six pts underwent AHCT post high dose Melphalan conditioning regimen. Treatment related AML/MDS occurred in 3/194 (1,5%) pts post conventional treatment and 9/ 166 (5,4%) post AHCT, with complex cytogenetic abnormalities, mainly of chromosomes 5, 7, 17 and 11. Two pts were diagnosed with solid tumors (breast and lung cancer) post AHCT (2/166). The pts diagnosed with a secondary malignancy were previously exposed in induction therapy to melphalan (6), VAD (3), Bortezomib (3), high-dose cyclophospamide as mobilization treatment (4) and radiotherapy (4). The median time from diagnosis to secondary malignancy was 64 (14-110) months. Survival after diagnosis of secondary malignancy was 4 months (1-130), while overall survival from diagnosis 68 months (26-178). Conclusions: In conclusion, it is not clear whether the myeloablative therapy used for AHCT is the leading cause for secondary malignancy or the conventional chemotherapy/radiotherapy administered for a prolonged period. Furthermore, the contribution of novel agents remains to be defined and new data are emerging considering their potential role. The prognosis of secondary malignancy is poor and
e200
-
15th International Myeloma Workshop, September 23-26, 2015
Introduction: Autologous hematopoietic cell transplantation (Auto-HCT) is considered standard of care for patients with multiple myeloma (MM). A commonly used criterion to deem patients ineligible for transplant is age >65 years. At our institution we do not use age to determine eligibility for transplant. Here we report the results of patients aged 65 years with MM who underwent Auto-HCT. Objective: To evaluate outcomes of Auto-HCT in a cohort of elderly patients (age 65 years) with MM. Patients: Median age at transplantation was 68 years (65 e 79 years). Twenty two (33%) patients were aged >70 years. Median HCT-CI score was 2 (range: 0-8). Thirty (45%) patients had an HCT-CI score of 3. Methods: We performed a retrospective analysis of 67 patients, who underwent Auto-HCT between December 1999 and December 2014 at the Allegheny Health Network Cancer Institute. The conditioning regimen was Melphalan 200 mg/m2. Non-relapse mortality (NRM) was assessed at day 100 post Auto-HCT. Results: Median time to Auto-HCT following diagnosis was 10.3 months (range: 4.9-126 months). Median time to ANC500 and PLT20 was 12 days (range: 10-18 days) and 18 days (range: 0-42 days) respectively. The probability of OS by Kaplan-Meier analysis for the entire cohort at 1, 2, 3, and 5 years was 88%, 83%, 73%, and 53%. The probability of OS by Kaplan Meier analysis for patients with HCT CI 3 at 1, 3 and 5 years was 97%, 85%, and 71%. One patient died from CMV pneumonia at day 51 resulting in NRM of 1.5%. Two patients died from progressive disease, one on day 25 and second on day 32. There was no mortality before day 100 after 2007. At a median follow-up of 12 years, the OS for patients who underwent transplantation prior to 2007 was 12%. For patients undergoing auto-HCT after 2007, OS at a median follow-up of 4.5 years was 70%. Conclusion: Auto-HCT in MM patients aged 65 years is safe and feasible. Age alone should not exclude patients for Auto-HCT. The excellent outcome following Auto-HCT after 2007 is likely due to improved supportive care and incorporation of novel agents.
early identification of patients at increased risk is of great importance for modifying treatment to minimize this risk.
Secondary Malignancies in Multiple Myeloma C. Vadikoliou,1 D. Malouri,1 M. Kaliou,1 Z. Bousiou,1 C. Lalayianni,1 A. Athanasiadou,1 E. Spanoudakis,2 K. Kokoviadou,3 I. Katodritou,4 V. Garypidou,5 G. Kiriazis,6 R. Saloum,1 I. Sakellari,1 A. Anagnostopoulos1 1
Haematology and Bone Marrow Transplantation Dpt, G. Papanikolaou Hospital Thessaloniki, Thessaloniki, Greece; 2Haematology Dpt.
PO-205 Autologous HCT in Elderly Myeloma Patients, AHNCI Single Institution Experience
of Democritus Univercity of Thrace, Thessaloniki, Greece; 3Haema-
E. Sahovic, N. Patel, S. Sadashiv, J. DeYao, G. Berteotti, J. Lister
tology Dpt Papageorgiou Hospital, Thessaloniki, Greece; 4Haema-
Allegheny Health Network Cancer Institute
tology Dpt Theagenio Hospital, Thessaloniki, Greece; 5Dpt. Of Internal medicine, AUTH, Hippokration Hospital, Immunology Lab., Thessaloniki, Greece; 6Pneumonology Dpt AUTH. G.Papanikolaou Hospital, Thessaloniki, Greece
Introduction/Background: A tremendous progress has been achieved in the era of multiple myeloma (MM) treatment with the emerge of novel agents. The number of long-term survivors is continuously rising and the risk of secondary malignancies is of great importance. Based on a restricted number of studies, prior treatment is considered the main risk factor for second malignancies. Chromosome 7 or 5 deletions are typical of alkylating agents’ related t-AML/MDS with an estimated risk of 1% -1.5% per year 2-10 years after the exposion. Radiotherapy is also a well-established risk factor for secondary malignancies. Materials and Methods: In this retrospective study, we evaluated the frequency of secondary malignancies, t-AML/MDS, solid tumors following chemotherapy/ radiotherapy or autologous haematopoietic cell transplantation (AHCT) in a cohort of 360 consecutive patients (pts) with a diagnosis of MM over a period of twenty years (1988-2015). Results: All patients (360) were treated with more than two lines of chemotherapy including alkylating agents. Primary treatment was :VAD in 114, Bortezomib-based in 94 and radiotherapy in 56 pts. One hundred sixty six pts underwent AHCT post high dose Melphalan conditioning regimen. Treatment related AML/MDS occurred in 3/194 (1,5%) pts post conventional treatment and 9/ 166 (5,4%) post AHCT, with complex cytogenetic abnormalities, mainly of chromosomes 5, 7, 17 and 11. Two pts were diagnosed with solid tumors (breast and lung cancer) post AHCT (2/166). The pts diagnosed with a secondary malignancy were previously exposed in induction therapy to melphalan (6), VAD (3), Bortezomib (3), high-dose cyclophospamide as mobilization treatment (4) and radiotherapy (4). The median time from diagnosis to secondary malignancy was 64 (14-110) months. Survival after diagnosis of secondary malignancy was 4 months (1-130), while overall survival from diagnosis 68 months (26-178). Conclusions: In conclusion, it is not clear whether the myeloablative therapy used for AHCT is the leading cause for secondary malignancy or the conventional chemotherapy/radiotherapy administered for a prolonged period. Furthermore, the contribution of novel agents remains to be defined and new data are emerging considering their potential role. The prognosis of secondary malignancy is poor and
e200
-
15th International Myeloma Workshop, September 23-26, 2015
Introduction: Autologous hematopoietic cell transplantation (Auto-HCT) is considered standard of care for patients with multiple myeloma (MM). A commonly used criterion to deem patients ineligible for transplant is age >65 years. At our institution we do not use age to determine eligibility for transplant. Here we report the results of patients aged 65 years with MM who underwent Auto-HCT. Objective: To evaluate outcomes of Auto-HCT in a cohort of elderly patients (age 65 years) with MM. Patients: Median age at transplantation was 68 years (65 e 79 years). Twenty two (33%) patients were aged >70 years. Median HCT-CI score was 2 (range: 0-8). Thirty (45%) patients had an HCT-CI score of 3. Methods: We performed a retrospective analysis of 67 patients, who underwent Auto-HCT between December 1999 and December 2014 at the Allegheny Health Network Cancer Institute. The conditioning regimen was Melphalan 200 mg/m2. Non-relapse mortality (NRM) was assessed at day 100 post Auto-HCT. Results: Median time to Auto-HCT following diagnosis was 10.3 months (range: 4.9-126 months). Median time to ANC500 and PLT20 was 12 days (range: 10-18 days) and 18 days (range: 0-42 days) respectively. The probability of OS by Kaplan-Meier analysis for the entire cohort at 1, 2, 3, and 5 years was 88%, 83%, 73%, and 53%. The probability of OS by Kaplan Meier analysis for patients with HCT CI 3 at 1, 3 and 5 years was 97%, 85%, and 71%. One patient died from CMV pneumonia at day 51 resulting in NRM of 1.5%. Two patients died from progressive disease, one on day 25 and second on day 32. There was no mortality before day 100 after 2007. At a median follow-up of 12 years, the OS for patients who underwent transplantation prior to 2007 was 12%. For patients undergoing auto-HCT after 2007, OS at a median follow-up of 4.5 years was 70%. Conclusion: Auto-HCT in MM patients aged 65 years is safe and feasible. Age alone should not exclude patients for Auto-HCT. The excellent outcome following Auto-HCT after 2007 is likely due to improved supportive care and incorporation of novel agents.