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Safety and efficacy of autologous stem cell transplantation in dialysis-dependent myeloma patients—The DIADEM study from the chronic malignancies working party of the EBMT

Bone Marrow Transplantation volume 58, pages 424–429 (2023)Cite this article

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Abstract

The role of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in the treatment of myeloma (MM) patients with severe and/or dialysis-dependent renal impairment remains uncertain. We report on the outcomes of 110 patients (median age 57 years) who had become dialysis-dependent pre-ASCT and who underwent a first ASCT between 1997 and 2017. Sixty-three (57%) patients had light chain MM. All patients required dialysis (94% hemodialysis and 6% peritoneal). Forty-four of 71 (62%) patients received bortezomib-based induction regimens and 42 (39%) patients had achieved at least a very good partial response (VGPR) pre-ASCT. Melphalan dosing was as follows: ≤140 mg/m2 (82%), and >140 mg/m2 (18%). The median PFS after ASCT was 35 months (95% CI: 21.5–42.2) and the median OS 102 months (95% CI: 70.4–129.1). At 1, 2, and 5 years after ASCT, 8% (95% CI 3–14%), 13% (6–20%), and 20% (12–29%) of patients, respectively, had achieved dialysis independence. In multivariate analyses of OS and PFS including age at ASCT, response at ASCT, and year of ASCT, younger age at ASCT and better response at ASCT (CR/VGPR/PR vs. MR/SD/progression) were significantly associated with better OS and PFS.

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Fig. 1: Progression-free survival (PFS) and overall survival (OS).
Fig. 2: Incidence of dialysis independence and death before dialysis independence.

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Data availability

The final analysis dataset is available upon request to the Working Party chair.

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Authors and Affiliations

  1. University Clinical Centre, Medical University of Warsaw, Warsaw, Poland

    Anna Waszczuk-Gajda & Joanna Drozd-Sokolowska

  2. EBMT Statistical Unit, Leiden, the Netherlands

    Luuk Gras

  3. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

    Liesbeth C. de Wreede

  4. EBMT Leiden Study Unit, Leiden, the Netherlands

    Tiarlan Sirait

  5. University of Debrecen, Faculty of Medicine, Debrecen, Hungary

    Arpad Illes

  6. Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey

    Zubeyde Nur Ozkurt

  7. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    John A. Snowden

  8. Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Istanbul, Turkey

    Mutlu Arat

  9. CHU Grenoble Alpes - Université Grenoble Alpes, Grenoble, France

    Claude Eric Bulabois

  10. Judith Niederland, HELIOS Klinikum Berlin-Buch, Berlin, Germany

    Judith Niederland

  11. University Medical Center, Ljubljana, Slovenia/Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Matjaz Sever

  12. Dept, of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Shankara Paneesha

  13. King’s College Hospital, London, UK

    Victoria Potter

  14. Alain Gadisseur, Antwerp University Hospital (UZA), Antwerp E, Belgium

    Alain Gadisseur

  15. Hopital Bretonneau, Tours, France

    Thomas Chalopin

  16. Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6229 HX, Maastricht, the Netherlands

    Gwendolyn Van Gorkom

  17. Hospital Univ. 12 de Octubre, Madrid, Spain

    Joaquin Martínez López

  18. Ghent University Hospital, Gent, Belgium

    Tessa Kerre

  19. University College London Hospitals NHS Trust, London, UK

    Kavita Raj & Donal P. McLornan

  20. Department of Haematology, School of Medicine, Trinity College Dublin, Dublin, Ireland

    Patrick J. Hayden

  21. Ankara University Faculty of Medicine, Ankara, Turkey

    Meral Beksac

  22. CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France

    Ibrahim Yakoub-Agha

  23. Medizinische Klinik u. Poliklinik V, University of Heidelberg, Heidelberg, Germany

    Stefan Schönland

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  1. Anna Waszczuk-Gajda
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Contributions

AW-G designed the study, interpreted the data, and wrote the first draft of the manuscript. The data was extracted and compiled by TS and the statistical analysis performed by LG and LCDW. PJH, MB, DPMcL, and SS interpreted the data and edited the manuscript. AI, ZNO, JAS, MA, CEB, JN, MS, SP, VP, AG, TC, GVG, JML, TK, JD-S, KR, and IYA reviewed the manuscript and provided clinical data. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Patrick J. Hayden.

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Waszczuk-Gajda, A., Gras, L., de Wreede, L.C. et al. Safety and efficacy of autologous stem cell transplantation in dialysis-dependent myeloma patients—The DIADEM study from the chronic malignancies working party of the EBMT. Bone Marrow Transplant 58, 424–429 (2023). https://doi.org/10.1038/s41409-023-01915-7

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