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High-dose chemotherapy and autotransplants for plasma cell myeloma in Jordan

Jordan (officially The Hashemite Kingdom of Jordan) is a small country (89,341 kmE + 2; 2016 population estimate, 9.5 million) with limited resources (per capita GDP $12,300 USD; World Rank, 123) and increasing cancer incidence including haematological neoplasms. In Jordan, there are four transplant centres performing 200–250 transplants annually, one-half allogeneic and the others autologous with a rate of 2–2.5/10 × 10E + 5 population. This is about fivefold lower than the European Union and United States [1, 2]. Number of Jordanians who might benefit from a haematopoietic cell transplant is increasing. There are, however, substantial barriers to meeting this need including the following: (1) few transplant centres; (2) few transplant specialists; (3) no bone marrow donor registry; (4) high cost; (5) unavailability of some commonly used transplant-related drugs such as carmustine and thiotepa; (6) no accommodations for patients and families near transplant centres; and (7) high proportion of non-Jordanians with no insurance coverage including many recent Syrian refugees. Consequently, many persons who might benefit from a transplant are never referred or are referred with advanced disease and substantial co-morbidities because of the complex referral system and lack of team coordination. Cancer treatment including transplants is free to Jordanian citizens, but not to non-citizens whose transplant costs are paid for out-of-pocket charities and rarely by their governments.

We describe outcomes of 94 consecutive persons with plasma cell myeloma receiving an autotransplant in the Department of Hematology and Oncology at King Hussein Cancer Center from January 2008 to December 2015. Written informed consent and Institutional Review Board approval were obtained for all subjects. Diagnosis was based on the International Myeloma Working Group criteria [3]. Subject-, disease- and transplant-related variables are shown in the Table 1. Outcomes were evaluated using the European Society for Blood and Marrow Transplantation response criteria [4]. Analyses of immunoglobulin levels, serum and urine protein electrophoreses, free immunoglobulin light chains and imaging studies were done in most subjects.

Table 1 Subject-, disease- and transplant-related variables

Subjects received intermediate-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) for blood cell mobilization. Conditioning was melphalan, 200 mg/mE + 2. Median CD34-positive cell dose was 4.84 ± 1.35E + 6 (SD). Subjects received standard infection prophylaxis.

All subjects had rapid bone marrow recovery. Median follow-up of survivors is 30 months (range, 53–62 months). Median estimated progression-free survival is 30 months (95% confidence interval 24,47 months). Estimated 5-year event-free survival is 29% (17, 42%). Estimated 5-year survival is 58% (43, 70%).

These data indicate successful delivery of high-dose melphalan and an autotransplant in persons with plasma cell myeloma in Jordan, with outcomes seemingly comparable to those reported by other centres in similar subjects.

References

  1. 1.

    Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, for the European Society for Blood and Marrow Transplantation (EBMT). et al. Hematopoietic stem cell transplantation in Europe 2014: more than 40,000 transplants annually. Bone Marrow Transplant. 2016;51:786–92.

    CAS  Article  Google Scholar 

  2. 2.

    D’Souza Anita, Lee Stephanie, Zhu Xiaochun, et al. Current use and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant. 2017;23:1417–21.

    Article  Google Scholar 

  3. 3.

    Rajkumar SV. Updated diagnostic criteria and staging system for multiple myeloma. Am Soc Clin Oncol Educ Book. 2016;35:e418–23. https://doi.org/10.14694/EDBK_159009

    Article  PubMed  Google Scholar 

  4. 4.

    Bladé J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT—European Group for Blood and Marrow Transplant. Br J Haematol. 1998;102:1115–23.

    Article  Google Scholar 

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Correspondence to Khalid Halahleh.

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Halahleh, K., Ma’koseh, M., Abu-Jazar, H. et al. High-dose chemotherapy and autotransplants for plasma cell myeloma in Jordan. Bone Marrow Transplant 53, 1349–1350 (2018). https://doi.org/10.1038/s41409-018-0201-x

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