Autologous haematopoietic stem cell transplantation in patients with multiple myeloma complicated by dialysis-dependent renal failure
- Authors: Firsova M.V.1, Mendeleeva L.P.1, Solovev M.V.1, Rekhtina I.G.1, Pokrovskaya O.S.1, Urnova E.S.1, Soboleva N.P.1, Dvirnyk V.N.1, Klyasova G.A.1, Kuzmina L.A.1, Savchenko V.G.1
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Affiliations:
- National Research Center for Hematology
- Issue: Vol 92, No 7 (2020)
- Pages: 70-76
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/43126
- DOI: https://doi.org/10.26442/00403660.2020.07.000777
- ID: 43126
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Abstract
Aim. To assess the safety and efficacy of autologous haematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with dialysis-dependent renal failure.
Materials and methods. During a period from May 2010 to December 2016 fourteen MM patients with dialysis-dependent renal failure aged 48 to 65 years underwent auto-HSCT. After the induction therapy complete response, very good partial response, partial response were documented in 64, 29, 7% of patients, respectively. In no case was a renal response achieved. Haematopoietic stem cell mobilization in most patients (13/14) was performed according to the scheme: G-CSF 10 μg/kg. Melphalan in 3 dosages was used as pre-transplant conditioning: 100, 140 and 200 mg/m2; 13 patients underwent a single and in one case underwent a tandem auto-HSCT against the background of hemodialysis. Evaluation of the antitumor and renal response was assessed on the 100th day after auto-HSCT. Subsequently, against the background of programmed hemodialysis and in the setting of high-dosed melphalan (100–200 mg/m2), 13 patients underwent a single and one patient underwent a tandem auto-HSCT. At +100 days after auto-HSCT, an antitumor response and renal response were assessed.
Results. The period of agranulocytosis after auto-HSCT was from 5 to 12 days (median 8,5) and was accompanied by infectious complications, cardiac and neurological dysfunctions. At +100 days after auto-HSCT, the complete response was confirmed in 71% patients and very good partial response was confirmed in 29% patients. The minimal renal response was registered in 2 patients (14%), hemodialysis was stopped. The transplant-related mortality was absent. After a median follow-up of 53 months 5-year progression-free survival was 59%, and overall survival was 93%.
Conclusion. Carrying out auto-HSCT in patients with dialysis-dependent renal failure contributed to the achievement of a minimal renal response in 14% of cases, which allowed these patients to stop hemodialysis. Patients whose conditioning regimen was performed using melphalan at a dose of 200 mg/m2 showed more frequent complications in the early post-transplant period compared to patients who received a lower dose of melphalan (100–140 mg/m2). Auto-HSCT in MM patients with dialysis-dependent renal failure is a feasible and effective treatment method, which in some cases contributes to independence from hemodialysis.
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##article.viewOnOriginalSite##About the authors
M. V. Firsova
National Research Center for Hematology
Author for correspondence.
Email: firs-maia@yandex.ru
ORCID iD: 0000-0003-4142-171X
к.м.н., науч. сотр. отд-ния интенсивной высокодозной химиотерапии парапротеинемических гемобластозов
Russian Federation, MoscowL. P. Mendeleeva
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-4966-8146
д.м.н., проф., зам. ген. дир. по научной работе и инновациям, зав. отд. химиотерапии парапротеинемических гемобластозов
Russian Federation, MoscowM. V. Solovev
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-7944-6202
к.м.н., зав. отд-нием интенсивной высокодозной химиотерапии парапротеинемических гемобластозов
Russian Federation, MoscowI. G. Rekhtina
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0001-5440-4340
д.м.н., зав. отд-нием химиотерапии плазмоклеточных дискразий
Russian Federation, MoscowO. S. Pokrovskaya
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-8657-4990
к.м.н., врач-гематолог отд-ния интенсивной высокодозной химиотерапии парапротеинемических гемобластозов
Russian Federation, MoscowE. S. Urnova
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-2206-6532
к.м.н., врач-гематолог отд-ния интенсивной высокодозной химиотерапии парапротеинемических гемобластозов
Russian Federation, MoscowN. P. Soboleva
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-1903-2446
врач централизованной клинико-диагностической лаборатории
Russian Federation, MoscowV. N. Dvirnyk
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0002-9877-0796
к.м.н., зав. централизованной клинико-диагностической лаб.
Russian Federation, MoscowG. A. Klyasova
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0001-5973-5763
д.м.н., проф., зав. лаб. клинической бактериологии, микологии и антибиотической терапии
Russian Federation, MoscowL. A. Kuzmina
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0001-6201-6276
к.м.н., зав. отд-нием интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным и дневным стационарами
Russian Federation, MoscowV. G. Savchenko
National Research Center for Hematology
Email: firs-maia@yandex.ru
ORCID iD: 0000-0001-8188-5557
акад. РАН, проф., ген. дир.
Russian Federation, MoscowReferences
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