Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma
BackgroundMelphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m2 on day 2 (D...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1310752/full |
| _version_ | 1797277192949858304 |
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| author | Aimee Merino Ryan Shanley Faridullah Rashid Jenna Langer Michelle Dolan Sarah Tu Najla El Jurdi John Rogosheske Kirollos Hanna Todd DeFor Murali Janakiram Daniel Weisdorf |
| author_facet | Aimee Merino Ryan Shanley Faridullah Rashid Jenna Langer Michelle Dolan Sarah Tu Najla El Jurdi John Rogosheske Kirollos Hanna Todd DeFor Murali Janakiram Daniel Weisdorf |
| author_sort | Aimee Merino |
| collection | DOAJ |
| description | BackgroundMelphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m2 on day 2 (D-2) (48 h prior to ASCT), but many institutions have since adopted a melphalan protocol with administration on day 1 (D-1) (24 h prior to SCT) or split dosing over the 2 days. The optimal timing of melphalan has yet to be determined.MethodsIn this single-center retrospective study, we analyzed transplant outcomes for patients between March 2011 and September 2020 admitted for high-dose, single-agent melphalan 200 mg/m2 on D-1 vs. D-2. The primary outcomes were time to neutrophil and platelet engraftment. Secondary outcomes include incidence of hospital readmission within 30 days, 2-year progression-free survival, and 2-year overall survival.ResultsA total of 366 patients were studied (D-2 n = 269 and D-1 n = 97). The incidence of high-risk cytogenetics was similar between the two groups (37% vs. 40%). Median days to absolute neutrophil count engraftment was similar at 11 days in the D-2 and D-1 cohort (n = 269, range 0–14, IQR 11–11 vs. n = 97, range 0–14, IQR 11–12). Median days to platelet engraftment >20,000/mcL was 18 days for D-2 melphalan (range: 0–28, IQR 17–20) versus 19 days for D-1 melphalan (range: 0–32, IQR 17–21). Overall survival at 2 years post-transplant was similar in both cohorts (94%; p = 0.76), and PFS was 70% in D-2 compared with 78% in D-1 (p = 0.15). In a multivariable model including age and performance status, hospital readmission within 30 days of transplant was higher in the D-1 cohort (odds ratio 1.9; p = 0.01).ConclusionThis study demonstrates similar neutrophil and platelet engraftment in D-1 and D-2 melphalan cohorts with similar 2-year PFS and OS. Either D-2 or D-1 melphalan dosing schedule is safe and effective. |
| first_indexed | 2024-03-07T15:45:06Z |
| format | Article |
| id | doaj.art-fdab20d9fb004254ad0ee996196098ae |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-07T15:45:06Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-fdab20d9fb004254ad0ee996196098ae2024-03-05T05:05:42ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-03-011510.3389/fimmu.2024.13107521310752Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myelomaAimee Merino0Ryan Shanley1Faridullah Rashid2Jenna Langer3Michelle Dolan4Sarah Tu5Najla El Jurdi6John Rogosheske7Kirollos Hanna8Todd DeFor9Murali Janakiram10Daniel Weisdorf11Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesDepartment of Medicine, University of Minnesota, Minneapolis, MN, United StatesDepartment of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United StatesDepartment of Medicine, University of Minnesota, Minneapolis, MN, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesDepartment of Medicine, University of Minnesota, Minneapolis, MN, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesDepartment of Medicine, City of Hope, Duarte, CA, United StatesBlood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United StatesBackgroundMelphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m2 on day 2 (D-2) (48 h prior to ASCT), but many institutions have since adopted a melphalan protocol with administration on day 1 (D-1) (24 h prior to SCT) or split dosing over the 2 days. The optimal timing of melphalan has yet to be determined.MethodsIn this single-center retrospective study, we analyzed transplant outcomes for patients between March 2011 and September 2020 admitted for high-dose, single-agent melphalan 200 mg/m2 on D-1 vs. D-2. The primary outcomes were time to neutrophil and platelet engraftment. Secondary outcomes include incidence of hospital readmission within 30 days, 2-year progression-free survival, and 2-year overall survival.ResultsA total of 366 patients were studied (D-2 n = 269 and D-1 n = 97). The incidence of high-risk cytogenetics was similar between the two groups (37% vs. 40%). Median days to absolute neutrophil count engraftment was similar at 11 days in the D-2 and D-1 cohort (n = 269, range 0–14, IQR 11–11 vs. n = 97, range 0–14, IQR 11–12). Median days to platelet engraftment >20,000/mcL was 18 days for D-2 melphalan (range: 0–28, IQR 17–20) versus 19 days for D-1 melphalan (range: 0–32, IQR 17–21). Overall survival at 2 years post-transplant was similar in both cohorts (94%; p = 0.76), and PFS was 70% in D-2 compared with 78% in D-1 (p = 0.15). In a multivariable model including age and performance status, hospital readmission within 30 days of transplant was higher in the D-1 cohort (odds ratio 1.9; p = 0.01).ConclusionThis study demonstrates similar neutrophil and platelet engraftment in D-1 and D-2 melphalan cohorts with similar 2-year PFS and OS. Either D-2 or D-1 melphalan dosing schedule is safe and effective.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1310752/fullmelphalanautologous stem cell transplantmyelomaengraftmentrehospitalization |
| spellingShingle | Aimee Merino Ryan Shanley Faridullah Rashid Jenna Langer Michelle Dolan Sarah Tu Najla El Jurdi John Rogosheske Kirollos Hanna Todd DeFor Murali Janakiram Daniel Weisdorf Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma Frontiers in Immunology melphalan autologous stem cell transplant myeloma engraftment rehospitalization |
| title | Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma |
| title_full | Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma |
| title_fullStr | Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma |
| title_full_unstemmed | Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma |
| title_short | Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma |
| title_sort | impact of melphalan day 1 vs day 2 on outcomes after autologous stem cell transplant for multiple myeloma |
| topic | melphalan autologous stem cell transplant myeloma engraftment rehospitalization |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1310752/full |
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