Jarosław Czyż1, Artur Jurczyszyn2, Aneta Szudy-Szczyrek3, Anna Koclęga4, Anna Jachalska5, Monika Dzierżak-Mietła4, Bartosz Puła6, Krzysztof Jamroziak6, Lidia Usnarska-Zubkiewicz7, Lidia Gil8, Joanna Romejko-Jarosińska9, Anna Waszczuk-Gajda10. 1. Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland. jczyz@onet.pl 2. Department of Clinical Hematology, Jagiellonian University Medical College, Kraków, Poland 3. Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland 4. Department of Bone Marrow Transplantation and Hematology-Oncology, Center of Oncology in Gliwice, Gliwice, Poland 5. Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland 6. Institute of Hematology and Transfusion Medicine in Warsaw, Warsaw, Poland 7. Chair and Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland 8. Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Science, Poznań, Poland 9. Department of Lymphoma, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland 10. Department of Hematology, Oncology and Internal Disease, Medical University of Warsaw, Warsaw, Poland
Abstract
INTRODUCTION: Deletion of chromosome 17p [del(17p)] in patients with multiple myeloma is associated with a poor prognosis. High‑dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of treatment in this population. OBJECTIVES: The aim of the study was to compare the treatment outcomes with high‑dose chemotherapy and ASCT with standard treatment in patients with del(17p). PATIENTS AND METHODS: We collected data from 12 Polish centers between 2011 and 2017. The records of 97 patients with p53 deletion were assessed, including 29 individuals treated with ACST and 68 receiving standard treatment alone. RESULTS: During the follow‑up, 45 patients died and the overall survival (OS) for the whole group was 33 months (range, 1-66 months), with a median progression‑free survival (PFS) of 13 months (range, 1-46 months). The prognostic factors of OS in a multivariable analysis were calcium levels at diagnosis within the reference range (hazard ratio [HR], 0.24; 95% CI, 0.12-0.48) and at least partial remission achieved after the first‑line treatment (HR, 0.25; 95% CI, 0.12-0.51). Treatment with ASCT was an important factor in improving survival (HR, 3.23; 95% CI, 1.52-6.84). Abnormal kidney function at the time of diagnosis reduced the PFS (HR, 0.46; 95% CI, 0.22-0.94). When the analysis was limited only to patients who could be candidates for ASCT, the survival benefit of the procedure was lost (P = 0.21). CONCLUSIONS: Patients with multiple myeloma with del(17p) do not benefit from high‑dose chemotherapy followed by ACST.
INTRODUCTION: Deletion of chromosome 17p [del(17p)] in patients with multiple myeloma is associated with a poor prognosis. High‑dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of treatment in this population. OBJECTIVES: The aim of the study was to compare the treatment outcomes with high‑dose chemotherapy and ASCT with standard treatment in patients with del(17p). PATIENTS AND METHODS: We collected data from 12 Polish centers between 2011 and 2017. The records of 97 patients with p53 deletion were assessed, including 29 individuals treated with ACST and 68 receiving standard treatment alone. RESULTS: During the follow‑up, 45 patients died and the overall survival (OS) for the whole group was 33 months (range, 1-66 months), with a median progression‑free survival (PFS) of 13 months (range, 1-46 months). The prognostic factors of OS in a multivariable analysis were calcium levels at diagnosis within the reference range (hazard ratio [HR], 0.24; 95% CI, 0.12-0.48) and at least partial remission achieved after the first‑line treatment (HR, 0.25; 95% CI, 0.12-0.51). Treatment with ASCT was an important factor in improving survival (HR, 3.23; 95% CI, 1.52-6.84). Abnormal kidney function at the time of diagnosis reduced the PFS (HR, 0.46; 95% CI, 0.22-0.94). When the analysis was limited only to patients who could be candidates for ASCT, the survival benefit of the procedure was lost (P = 0.21). CONCLUSIONS:Patients with multiple myeloma with del(17p) do not benefit from high‑dose chemotherapy followed by ACST.