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PS-162 A retrospective cohort study to evaluate the outcomes of multiple myeloma treated in a tertiary care centre from India

In Clinical Lymphoma, Myeloma & Leukemia
By: Chanana R.
Contributor(s): Sengar M | Jain H | Khattry N | Bagal B | Philip D | Punatar S | Gokarn A | Menon H | Kadam M | Pawaskar P.
Material type: materialTypeLabelArticlePublisher: New York : Elsevier, 2017Description: .Subject(s): Myeloma | Tertiary careOnline resources: PDF In: Clinical Lymphoma, Myeloma & Leukemia Vol. 17, p. e131Summary: Background Multiple myeloma is a disease of elderly with a median age of presentation 70 years and accounts for 1% of all cancers. One of the major advances in the management of newly diagnosed myeloma patients has been the introduction of novel drugs as part of front line therapy. Both VTD and VCD regimens are efficacious and well-tolerated regimens. The overall response rates range from 70%-90%. However, scenario is different in our country, given the delayed presentations, decreased compliance, socioeconomic factors and significant delay in diagnosis and initiation of chemotherapy. We evaluated the outcomes of patients of Myeloma treated at our centre. Methods We retrospectively analysed Myeloma patients who were treated with different regimens at Tata Memorial Centre from January 2013 till December 2014. Patients aged ≥18 years who were diagnosed as Myeloma were included in the analysis. The primary objective was the overall survival (OS), secondary objectives were response rates, progression free survival and toxicity profile. Descriptive statistics were summarized with median and range, survival outcomes were analysed with Kaplan-Meier method and impact of different ISS stage on survival was assessed using log rank test Results Conclusions A total of 185 patients (145 males) with a median age of 58 years were treated. 45, 50 and 87 patients belonged to ISS Stage I, II and III respectively. For 3 patients baseline staging was not available. Bony lesion and anemia were present in 164 patients and 89 patients. Hyperdiploidy was the most common cytogenetic abnormality detected in 57% of patients, followed by gain (1q) (27%). 10 (5.4%), 75 (40.5%) and 82 patients (44.2%) belonged to high, intermediate and standard risk, respectively. 18 patients were not risk stratified at baseline. VCD was the common initial regimen used in 132 (71.3%) patients. 30 patients (16.2%) were treated by lenalidomide and dexamethasone and CTD was given to 15 patients as first line regimen. Only 72.9 % patients were able to complete the planned first line regimen. Based on limited toxicity data, grade 3/4 anemia, neutropenia and thrombocytopenia were present in 7.56%, 2.7%and 3.6% patients respectively. Grade 2 and 3 peripheral neuropathy was present in 16 (8.6%) patients and 6 (3.2%) patients respectively. After first line therapy, 16 patients were in CR (8.6%) and 49.7% were in VGPR, 17.8% in PR and 3.7% in SD and 9 patients progressed and for 28 patients, response evaluation was not available. The median PFS and OS for Stage I, II and III was 24 months, 17 months and 15 months respectively and 39 months, 26 months and 25 months respectively. After a median follow up of 30 months, 27 patients were lost to follow up and 26 patients died. Conclusion Median age of presentation is a decade earlier in Indian population. The overall response rates and survival data of our centre is inferior as compared to published data.
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Articles Articles Tata Memorial Hospital
Available AR18279

Published in 16th International Myeloma Workshop, March 1-4, 2017

Background Multiple myeloma is a disease of
elderly with a median age of presentation 70 years and accounts for 1% of all cancers. One of
the major advances in the management of newly
diagnosed myeloma patients has been the
introduction of novel drugs as part of front line
therapy. Both VTD and VCD regimens are
efficacious and well-tolerated regimens. The
overall response rates range from 70%-90%.
However, scenario is different in our country,
given the delayed presentations, decreased
compliance, socioeconomic factors and
significant delay in diagnosis and initiation of
chemotherapy. We evaluated the outcomes of
patients of Myeloma treated at our centre.
Methods We retrospectively analysed Myeloma
patients who were treated with different
regimens at Tata Memorial Centre from January
2013 till December 2014. Patients aged ≥18
years who were diagnosed as Myeloma were
included in the analysis. The primary objective
was the overall survival (OS), secondary
objectives were response rates, progression free
survival and toxicity profile. Descriptive
statistics were summarized with median and
range, survival outcomes were analysed with
Kaplan-Meier method and impact of different
ISS stage on survival was assessed using log
rank test Results Conclusions A total of 185
patients (145 males) with a median age of 58
years were treated. 45, 50 and 87 patients
belonged to ISS Stage I, II and III respectively.
For 3 patients baseline staging was not
available. Bony lesion and anemia were present
in 164 patients and 89 patients. Hyperdiploidy
was the most common cytogenetic abnormality
detected in 57% of patients, followed by gain
(1q) (27%). 10 (5.4%), 75 (40.5%) and 82
patients (44.2%) belonged to high, intermediate
and standard risk, respectively. 18 patients were
not risk stratified at baseline. VCD was the
common initial regimen used in 132 (71.3%)
patients. 30 patients (16.2%) were treated by
lenalidomide and dexamethasone and CTD was
given to 15 patients as first line regimen. Only
72.9 % patients were able to complete the
planned first line regimen. Based on limited
toxicity data, grade 3/4 anemia, neutropenia and
thrombocytopenia were present in 7.56%, 2.7%and 3.6% patients respectively. Grade 2 and 3
peripheral neuropathy was present in 16 (8.6%)
patients and 6 (3.2%) patients respectively.
After first line therapy, 16 patients were in CR
(8.6%) and 49.7% were in VGPR, 17.8% in PR
and 3.7% in SD and 9 patients progressed and
for 28 patients, response evaluation was not
available. The median PFS and OS for Stage I,
II and III was 24 months, 17 months and 15
months respectively and 39 months, 26 months
and 25 months respectively. After a median
follow up of 30 months, 27 patients were lost to
follow up and 26 patients died. Conclusion
Median age of presentation is a decade earlier in
Indian population. The overall response rates
and survival data of our centre is inferior as
compared to published data.

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