Autologous stem cell transplantation in the treatment of multiple myeloma with 17p deletion.

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.