IgD multiple myeloma a descriptive report of 17 cases: survival and response to therapy
Francesco Pisani1, Maria Teresa Petrucci, Diana Giannarelli
1Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy. fr.pisani@tiscali.it
Background:
Immunoglobulin D multiple myeloma (MM) is rare and has a poorer prognosis than other MM isotypes.
Design And Methods:
Seventeen patients (pts) diagnosed from 1993 to 2009 with IgD MM were selected from six institutions of Multiple Myeloma Latium-Region GIMEMA Working Group.
Results:
Median age was 55 years, 14 patients had bone lesions, eight had renal impairment with estimated glomerular filtration rate (eGFR) < 50 ml/min, one serum calcium ≥ 12 mg/dl, 11 had lambda light chains, five stage III of ISS, six with chromosomal abnormalities. Six pts received conventional chemotherapy (CT): five melphalan + steroids based regimens. Eleven underwent high-doses of chemotherapy with autologous stem cell transplantation (HDT/ASCT), five single and six tandem ASCT: six received bortezomib and/or thalidomide as induction therapy and five VAD. Thalidomide maintenance was used in two pts: one in HDT/ASCT and one in CT group; bortezomib was used in one patient after HDT/ASCT. At a median follow up of 38 (range 19-60) and 50 months (range 17-148) for pts treated with CT and HDT/ASCT, respectively, the overall response rate (ORR) was 83% and 90%. In the group of patients treated with CT, median overall survival (OS) was 34 months (95% CI 15- 54 months), median progression free survival (PFS) was 18 months (95% CI 3-33 months) and median duration of response (DOR) was 7 months (95% CI 5-9 months). Median OS, PFS and DOR were not reached at the time of this analysis in the HDT/ASCT group of patients. Death was observed in 27.3% of pts treated with HDT/ASCT and in 66.7% undergone CT.
Conclusions:
Despite the retrospective analysis and the small number of pts our study showed that the use of HDT/ASCT seems to improve also the prognosis of IgD MM patients. Treatment options including new drugs, before and after stem cell transplantation, may further improve the outcomes of these patients.
Insights
High-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) appears to improve outcomes for patients with rare Immunoglobulin D multiple myeloma (IgD MM). Further research into novel therapies may enhance survival for these patients.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Immunoglobulin D multiple myeloma (IgD MM) is a rare subtype of multiple myeloma.
- IgD MM is associated with a poorer prognosis compared to other multiple myeloma isotypes.
Purpose of the Study:
- To evaluate the effectiveness of high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) in patients with IgD MM.
- To compare outcomes between patients treated with conventional chemotherapy (CT) and HDT/ASCT.
Main Methods:
- Retrospective analysis of 17 IgD MM patients diagnosed between 1993 and 2009.
- Patients were treated with either conventional chemotherapy (CT) or HDT/ASCT, with some receiving novel agents like bortezomib or thalidomide.
Main Results:
- HDT/ASCT showed a higher overall response rate (90%) compared to CT (83%).
- Patients undergoing HDT/ASCT had not reached median overall survival, progression-free survival, or duration of response at follow-up.
- Mortality was lower in the HDT/ASCT group (27.3%) compared to the CT group (66.7%).
Conclusions:
- HDT/ASCT may improve the prognosis for patients with IgD MM.
- Incorporating novel drugs before and after stem cell transplantation could further enhance treatment outcomes for IgD MM.
