Retrospective analysis of patients diagnosed with multiple myeloma: A single center experience

INTRODUCTION: Multiple myeloma is a hematological malignancy which is proceeding with the uncontrolled proliferation of plasma cells. Patients should be determined more definitely and treatments should be standardized to modify various treatment options in multiple myeloma. The aim of this study is to analyse the responses to treatments and the association between clinical features and treatments of multiple myeloma patients.
METHODS: The clinical and laboratuary findings with survival and treatment response data of 151 multiple myeloma patients who have been followed between 2000-2011 were analysed retrospectively.
RESULTS: The most prefered treatments were melphalan-prednisolone (45%), vincristin-adriamicin-dexamethasone (21,3%) and vincristin-adriamicin-dexamethasone followed by bortezomib (10%). Death was observed in 22,35% of the patients that remission was established at least for once. This rate was 77,35% in the patients that remission could not be established (p=0,000). Remission rate was significantly decreased (p=0.008) and death rate was significantly increased (p=0.000) in stage III disease compared with lower stages. Autologous stem cell transplantation, significantly decreased the relapse rate (p=0.009) and death risk (p=0.001). When the treatment protocols were analyzed, remission rate was 57,9% with vincristin-adriamicin-dexamethasone followed by bortezomib, 33,3% with melphalan-prednisolone, 29,2% with bortezomib, 9,4% with thalidomide, 23,8% with lenalidomide and 25,7% with vincristin-adriamicin-dexamethasone, respectively. Maintenance therapy with low dose lenalidomide was administered to 23 of 101 patients that remission was maintained. Autologous stem cell transplantation was administered to 21 patients that remission was obtained. Recurrence rate was significantly lower in patients who were received low dose lenalidomide maintenance therapy (p=0.002) (OR: 12,52).
DISCUSSION AND CONCLUSION: The highest remission rates were obtained with vincristin-adriamicin-dexamethasone followed by bortezomib. Lower recurrence and death rates were established with autologous stem cell transplantation. Recurrence and death rates were found lower in patients that received low dose lenalidomide maintenance therapy.

Multipl myelom tanýlý hastalarýn retrospektif analizi: Tek merkez deneyimi

GÝRÝÞ ve AMAÇ: Multipl myelom, plazma hücrelerinin kontrolsüz proliferasyonu ile seyreden hematolojik bir malignitedir. Multipl myelom tedavisindeki çeþitli seçenekler, hastalarýn daha iyi tanýmlanmasý ve tedavilerin standardize edilmesini gerektirmektedir. Bu çalýþmada multipl myelom hastalarýnýn tedavi yanýtlarýnýn deðerlendirilmesi ve klinik bulgularla iliþkisinin araþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: 2000-2011 yýllarýnda izlenmiþ olan 151 multipl myelom tanýlý hastanýn klinik ve laboratuar bulgularý ile saðkalým ve tedavi yanýtý verileri retrospektif olarak incelenmiþtir.
BULGULAR: En çok seçilen tedavi melfalan-prednizolon (%45), vinkristin-adriamisin-deksametazon (%21,3) ve vinkristin-adriamisin-deksametazon ardýndan bortezomib (%10) olmuþtur. En az 1 kez remisyon saptanan hastalarýn %22,35’inde ölüm görülmüþtür. Bu oran remisyon saðlanamayan hastalarda %77,35 olarak bulunmuþtur (p=0.000). Evre III hastalýkta daha düþük evrelere göre remisyon oraný anlamlý olarak azalmýþ (p=0.008) ve ölüm riski anlamlý olarak artmýþtýr (p=0.000). Otolog kemik iliði transplantasyonu, nüks riskini (p=0.009) ve ölüm riskini anlamlý olarak azaltmýþtýr (p=0.001). Tedavi þemalarý deðerlendirildiðinde sýrasýyla remisyon oranlarý vinkristin-adriamisin-deksametazon ardýndan bortezomib tedavisiyle %57,9, melfalan-prednizolon ile %33,3, bortezomib ile %29,2, talidomid ile %9,4, lenalidomid ile %23,8 ve vinkristin-adriamisin-deksametazon tedavisiyle %25,7 olarak bulunmuþtur. Remisyon saðlanan 101 hastanýn 23’üne düþük dozlu lenalidomid tedavisi verilmiþ ve 21 hasta otolog kemik iliði transplantasyonuna gönderilmiþtir. Nüks oraný düþük dozlu lenalidomid tedavisi uygulanan hastalarda anlamlý olarak düþük bulunmuþtur (p=0.002, OR: 12,52).
TARTIÞMA ve SONUÇ: En yüksek remisyon oranlarý vinkristin-adriamisin-deksametazon ardýndan bortezomib tedavisi ile saðlanmýþtýr. Otolog kemik iliði transplantasyonu ile daha düþük nüks ve ölüm oranlarý saptanmýþtýr. Düþük dozlu lenalidomid tedavisi uygulanan hastalarda ölüm ve nüks oraný daha düþük bulunmuþtur.