Autologous Hematopoietic Stem Cell Transplantation in Dialysis-Dependent Myeloma Patients

We retrospectively analyzed our transplant database from July 2000 to June 2012 to identify myeloma patients who received autologous stem cell transplantation while dialysis-dependent.

2091 patients underwent autologous high-dose therapy during this period. Twenty-four patients were dialysis-dependent.

The 100-day and the 6, and 12-month treatment-related mortality was 0%. Overall response rate was 92%. The median progression-free survival and overall survival were 1.9 years and 3.8 years, respectively. A multivariate analysis was not performed because of the small sample size. Only 3 patients became dialysis-independent after transplantation. Cardiac, gastrointestinal, genitourinary, infectious, neurologic, and pulmonary "all grade" toxicities were all higher in the melphalan 200 group versus < 200 group, however, none of them were statistically significant.

Because of a lack of clear survival benefit with higher-dose melphalan and potential higher toxicity in this group, it is reasonable to use lower-dose melphalan in dialysis-dependent myeloma patients.