Retrospective Analysis of Patients with Multiple Myeloma Post Autologous Stem Cell Transplant

Introduction: Multiple myeloma is a plasma cell disorder characterised by hypercalcaemia, renal dysfunction, and anaemia with bony lytic lesions. While multiple myeloma remains incurable, advancements in treatment have significantly improved patient outcomes. The choice of treatment depends on factors such as disease stage, patient age, overall health, and specific genetic abnormalities if present. Induction therapy typically includes proteasome inhibitors and dexamethasone with immunomodulators. Following induction, an autologous stem cell transplant recommended as a consolidative therapy for multiple myeloma. In our study, we retrospectively analysed 40 patients with multiple myeloma who underwent autologous stem cell transplants between January 2020 and December 2024. Aim: To assess disease characteristics, transplant-related complications, and outcomes in patients undergoing autologous stem cell transplant for multiple myeloma. Results: A total of 40 patients were evaluated. 32 (80%) were male, and 8 (20%) were female. Of these, 20 were under 50 years old, and 20 were over 50 years old. The most common co-morbidity was hypertension (HTN) in 6 (15%). Twenty-one (52.5%) had IgG Kappa disease. Twenty-four (60%) patients were in ISS I at the time of transplant. The most frequently used chemotherapy was VRD (Bortezomib, Lenalidomide, and Dexamethasone) in 33 (82.5%) cases. The disease assessment after chemotherapy showed that 18 (45%) patients achieved VGPR; 13 (32.5%) were in CR; and 9 (22.5%) were in PR before undergoing stem cell transplant. All patients received Inj Melphalan 200 mg/m2 or 140 mg/m2 as a conditioning regimen. The median stem cell dose was 7.54 x 10^6 cells/kg (interquartile range 2.59–23.9 million cells/kg). Transplantrelated complications included febrile neutropenia in 39 (96%), mucositis in 40 (100%), vomiting in 36 (90%), pneumonia in 5 (12.5%), and perianal complications in 12 (30%) patients. The mean hospital stay from stem cell rescue to discharge was 12 days. No mortality was observed during the hospital stay or until 100 days after the stem cell transplant. At a median follow-up of 21 months, biochemical relapse was documented in 5 (12.5%) patients, while clinical relapse occurred in 4 (10%). Overall survival at 12 months was 97.5%. Conclusion: Day 30 and Day 100 mortality was 0%, with a 1-year survival rate of 97.5% (at a median followup of 21 months). The 1-year cumulative probability of event-free survival was 87.5%.