The evaluation of multiple myeloma patients retrospectively followed by Dokuz Eylul University Hematology Department

Multipl Myeloma is a neoplastic plasma-cell disorder that is characterized by clonal proliferation of malignant plasma cells in the bone marrow microenvironment, monoclonal protein in the blood or urine, and associated organ dysfunction. It accounts for 1% of all malignancies in adults and 10-15 % of hematologic malignancies. Median survival period for patients with multipl myeloma in conventional chemotherapies prior to autologous stem cell transplantation was restricted with 2-3 years. Although there have been tremendous developments in the treatment of myeloma in the past 10 years, there have been growth in the survival period and responses to the treatment of the patients.In this study, it was aimed to obtain demographical data, general clinical properties, prognostic markers, treatments, responses to treatments and carry out overall survival analyses of the 119 multiple myeloma patients followed by Dokuz Eylül University Medicine Faculty Hematology Department between 2000-2011 years.The outcomes of 119 patients who were followed by the diagnosis of multipl myeloma were examined retrospectively to that end. Individuals were only included in the study who had treatment indication and whose file records were reached. The responses to treatment were evaluated according to the response criteria of IMWG and IBMTR.Median age of the patients was 61 (ranging from 29-89) and 58,8 % of them was male, 41,2 % of them was female. Paraprotein types were %38,7 IgG Kappa, %11,8 IgG Lambda, %19,3 IgA Kappa, %9,2 IgA lambda, %12,6 Kappa light chain, %5,9 Lambda light chain and %2,5 nonsecretory. 11% of the patients had Durie-Salmon Stage 1, 39,2 % of them Stage 2 and 49,8% of them Stage 3. When ISS stages were reviewed, 40% of 95 patients whose ß-2 microglobulin was checked was in ISS Stage 1, 36,8% ISS Stage 2, 23,2% ISS Stage 3. Median follow up period of the patients was 28 months. In terms of ISS Stage of the patients, no statistically significant difference was determined among median survival periods of them (p=0,73). It was observed that in the first line treatment, 51 patients received VAD, 46 had cyclophosphamide + dexamethasone, 14 had MP, 8 patients had other regimens (MPV, MPT, high dose dexamethasone). There was no statistically difference established when the overall response rates of the patients having VAD or cyclophosphamide + dexamethasone were examined in the first line therapy (According to IMWG p=0,15, IBMTR p=0,10). Second line treatment was applied to 95 patients (79,8%). 59 of them had a treatment based on bortezomib (30 patients had bortezomib, 23 bortezomib+dexamethasone, 6 bortezomib+cyclophosphamide+ dexamethasone), 22 OKIT, 9 had treatment based upon thalidomide (8 had thalidomide+ dexamethasone, 1 thalidomide), 5 patients had other regimens (MP, VAD). When overall response rates of patients applied OKIT or having bortezomib based therapy as a second line treatment were analyzed, no difference was identified statistically (according to IMWG p=0,51, IBMTR p=0,69). OKIT was performed to 56 patients. 3 patients died in the first 100 days before their responses were assessed followed by OKIT. The response of OKIT could not be evaluated in 3 patients owing to being in 100 days after OKIT application. The transplant associated mortality rate was 5,4%. When OKIT responses were considered, CR was observed in 12 patients (24%), VGPR in 26 (52%), PR in 6 (12%), stabile disease in 5 (10%), relapse from complete remission was seen in 1 patient (2%). Estimated median overall survival period was found as 71 months in patients with OKIT. Anticipated median overall survival period for patients having merely chemotherapy was 59,3 months. The difference between survial periods was close to significant statistically (p=0,058). The survival period without progression of patients with OKIT was 13,5 months (3-39 months). When OKIT responses of patients with bortezomib and without bortezomib were evaluated, overall responses of patients having bortezomib were statistically better according to IMWG (P=0,029). No significant difference was determined between two groups according to IBMTR (p=0,09). When the effects of bortezomib treatment were researched in relapsed-refractory disease, the average survival period of patients receiving bortezomib was discovered as 29,7 months (4-78 months). In relapsed-refractory disease, amid patients having bortezomib treatment CR was seen in 1 (5,5%), VGPR in 4 (22,2%), PR in 2 (11,1%), stabile disease in 5 (27,7%), progressive disease in 6 (33,3%) patients according to IMWG. The median overall survival period was 28 months (2-116 months) for all patients in our study. The median survival period without progression for all myeloma patients was 17 months (2-55 months). It was seen that 37 patients (31,1%) lost their lives and 82 (68,9%) were alive in 11 year follow-up period. 7 patients died due to disease progression and 15 died on account of infection.Demographic data and findings for our patients were simiar to those studies in the literature. The responses of the treatment and overall survival will be better in our country thanks to medicines used in myeloma first line treatment such as immunomodulatory drugs and bortezomib.