Epidemiological, clinical and pronostic aspects of multiple myeloma eligible for therapeutic intensification followed by autologous hematopoietic stem cell in the Algerian West: report of 147 cases

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Published Dec 22, 2017
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Vol. 95 No. 6 (2017): Issue Jun 2017

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Latifa Mohammadi
Noria Harir
Mohamed Brahimi
Soraya Moulessehoul
Mohamed Amine Bekadja

Abstract


Background: Multiple Myeloma (MM) represent about 1 to 2% of cancers and 15% of all hematological malignancies. It is characterized by malignant proliferation of plasmocytes in bone marrow and an excess of secreted monoclonal immunoglobulins (Ig)

Objective: Describe the epidemiological, clinical, biological and prognosis of patients with MM treated with autologous peripheral hematopoietic stem cell transplantation (APHSCT) in the Algerian West.

Methods: It is a retrospective descriptive study covering all MM patients treated with APHSCT over a period of 7 years (2008-2015) at service of Haematology and Cell Therapy of the EHU "1er November 1954 of Oran, Algeria Results: During the study, we collected 147 MM patients treated with APHSCT. The median age of the population was 53 years with a male predominance and a sex ratio of 1.53. Clinically, bone syndrome was found in 75.51% of cases. Paraclinaclly, anemia was found in 78.52% of patients, hyperprotidemy in 59.06%. A monoclonal peak in serum protein electrophoresis was noted in 80.54% of cases. Isotype repartition was: IgG (61.04%), IgA (19.17%), monoclonal light chains (16.11%). A plasmocytosis more than 10% was detected in 89.79% of cases. According to the Durie and Salmon classification, all of our patients were classified as stage III. The average survival time was thirty months.

Conclusion: The majority of our patients had advanced stage of MM to the presentation and the median survival was not reached thus emphasizing a high rate of remission and marks an important advance in the care of MM in Algeria.

Keywords:

Multiple Myeloma; ITS-ATG; epidemiology; clinical; survival; Algerian West

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References

  1. Manier S, Leleu X. Myélome multiple : diagnostic clinique et perspective de traitement. Recommandations de l'International Myeloma Working Group (IMWG). Immunoanal Biol Spec 2011; 26:125-36
  2. Bouatay A, Hizem S, Ben Youssef Y, Sayari F, Brahama N, Khélif A, Kortas M. Myélome multiple: aspect clinique, diagnostic biologique et pronostic. Immunoanal Biol Spec 2013; 28: 30-5
  3. Facon T, Yacoub-Agha I, Leleu X. Myélome multiple. EMC hématologie, 2003; 13-014-E-10:15
  4. Rajkumar SV, Kyle RA. Diagnosis and treatment of multiple myeloma. In: Neoplastic diseases of the blood. 5th ed. Springer, New York, USA 2013; 5: 637-63
  5. Chombart B, Gagneux-Lemoussu L, Eschard JP, Ackah-Miezan S, Novella JL, Brochot P. Facteurs pronostiques du myélome utilisables en pratique courante : suivi sur dix ans de 148 malades âgés de plus de 55 ans. Rev Rhu 2005; 72: 1299-305.
  6. Ndiaye FSD, Pouye A, Fall S, Diallo S, Ndongo S, El Kacimi S, Moreira Diop T. Présentation clinique du myélome multiple à Dakar (Sénégal): à propos de 71 observations. J Afr Cancer 2011; 3: 8-11
  7. Koreth J, Cutler CS, Djulbegovic B, Behl R, Schlossman RL, Munshi NC, Richardson PG, Anderson KC, Soiffer RJ, Alyea EP 3rd. High-dose therapy with single autologous transplantation versus chemotherapy for newly diagnosed multiple myeloma: A systematic review and meta-analysis of randomized controlled trials. Biol Blood Marrow Transplant 2007; 13(2): 183-96
  8. Fermand JP, Katsahian S, Divine M, Leblond V, Dreyfus F, Macro M, Arnulf B, Royer B, Mariette X, Pertuiset E, Belanger C, Janvier M, Chevret S, Brouet JC, Ravaud P; Group Myelome-Autogreffe. High-dose therapy and autologous stem cell compared with conventional treatment in myeloma patients aged 55 to 65 years: long term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol 2005; 23: 9227-9233
  9. Levy V, Katsahian S, Fermand JP, Mary JY, Chevret S. A meta-analysis on data from 575 patients with multiple myeloma randomly assigned to either high dose therapy or conventional therapy. Medicine 2005; 84: 250-260
  10. Bidet A, Marit G, Bérard A M. Intérêt du dosage des chaînes légères libres des immunoglobulines. Spectra biologie 2007; 157:42-47
  11. Kyle R. Rajkumar SV. Multiple myeloma. Blood 2008; 111 : 2662-2972
  12. Blade J, Esteve J, Rives, Martinez C, Rovira M, Urbano-Ispizua A et al. Hig-dose therapy auto transplantation intensification vs continued standard chemotherapy in multiple myeloma in first remission. Results of a non-randomized study from a single institution. Bone Marrow Transplant 2000; 26: 845- 849
  13. Richez V, Malard F. Focus sur la prise en charge therapeutique du myelome multiple. Hematologie 2014 ; 20 : 229-236
  14. Wisløff F, Andersen P, Andersson TR, et al. Has the incidence of multiple myeloma in old age been underestimated? The myeloma project of health region I in Norway. I. Eur J Haematol 1991; 47:333-7
  15. Pascaud F, Tavernier C, Lavault F, et al. Myélome multiple chez les sujets de plus de 80 ans, facteurs pronstiques. Sem.Hôp. Paris 1989; 65 :2577-2581
  16. Kyle RA. Multiple myeloma: review of 869 cases. Mayo Clin Proc 1975; 50:29-40
  17. Chkir S, Ezzeddine M, Baklouti S.Le myélome multiple : à propos de 25 cas. Ann Gerontol 2010; 3:41-4
  18. Hurez D. Épidémiologie des gammapathies monoclonales. Rev Prat 1993 ; 43:3
  19. Raab MA, Podar K, Breitkreutz I, et al. Multiple myeloma. Lancet 2009 ; 374:324-39
  20. Blade J, Fernandez-Lama P, Bosch F, Montoliu J, Lens XM, Montoto S, et al. Renal failure in multiple myeloma: presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 1998; 158:1889-93
  21. The Nordic Myeloma Study Group Knudsen LM et al. Renal function in newly diagnosed multiple myeloma: ademographic study of 1353 patients. Eur J Haematol 1994; 53:207-12
  22. Kyle RA, Rajkumar SV. Epidemiology of the plasma-cell disorders. Best Pract Resh Clin Haematol 2007; 20(4):637—64
  23. Gueye I. Les hémopathies malignes de l'adulte à l'hôpital principal de Dakar : étude rétrospective de 2002 à 2005, à propos de 101 cas. Thèse de médecine, Dakar, 2006 ; n°29
  24. Belot A, Grosclaude P, Bossard N, et al. Cancer incidence and mortality in France over the period 1980-2005. Rev Epidemiol Sante Publique 2008; 56(3):159-75
  25. Makni S, Zouari R, Barbouch MR, Ayed K, Moalla M, Zakraoui L. Gammapathies monoclonales en Tunisie. Rev Fr Transfus Hem 1990; 33:31-8
  26. Kyle RA, Gertz MA, Witzig TA, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78:21-33
  27. Gaougaou N, L. Bahri, A. Quessar, et al. Présentation épidémiologique, clinique, biologique et pronostique du myélome multiple à Casablanca (Maroc). J. Afr. Cancer 2014 ; 6:159-165
  28. Bladé J, Rosinol L. Renal hematologic and infectious complications in multiple myeloma. Best Pract Res Clini Haematol 2005; 18(4):635-52
  29. Bartl R, Frisch B. Diagnostic morphology in myeloma multiple. Current Diagn Pathol 1995; 2:222-35
  30. Makni H, Gargouri J, Frikha M, Fakhfakh F. Analyse cytologique et immunochimique de 40 cas de myélome multiple. Tunis Med 1994 ; 72:707-12
  31. Ben Abid H, Meddeb BH, Hafsia R, et al. Survie à long terme et facteurs pronostiques du myélome multiple traité par chimiothérapie conventionnelle. À propos de 109 cas. Tunis Med 2000 ; 78:705-12
  32. Diem H, Lamerz R. Pronostic factors in multiple myeloma, role of β2-microglobulin and thymidine kinase. Clin Invest 1993; 71:918-23
  33. Kyle RA. Sequence of Testing for Monoclonal Gammopathies. Arch Pathol Lab Med 1999; 123(2):114-8
  34. Lodé L, Wuillème S, Avet-Loiseau H. Facteurs pronostiques biologiques dans le myélome multiple. Hématologie 2005; 11:346-50
  35. Aucouturier P, Preudhomme JL. Diagnostic biologique des immunoglobulines monoclonales. Rev Prat 1993; 43:285 -8
  36. Pertuiset E. Survie à long terme et facteurs pronostiques du myélome multiple stades II-III traité par chimiothérapie conventionnelle. Ann Med Interne 1992 ; 143:516-24
  37. Harousseau JL. Ten years of improvement in the management of multiple myeloma: 2000-2010. Clin Lymphoma Myeloma Leuk 2010; 10(6):424-42
  38. Harousseau JL, Avet-Loiseau H, Mary JY, et al. Bortezomib plus dexamethasone versus reduced-dose bortezomib plus thalidomide dexamethasone as induction prior to autologous transplantation in newly diagnosed myeloma. Haematologica 2010; 95:451 [abs. 1097]
  39. Attal M, Harousseau JL, Stoppa AM, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du myélome. N Engl J Med 1996; 335:91-7
  40. Kumar L, Ghosh J, Ganessan P, G upta A, Hariprasad R, Kochupillai V. High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country. Bone Marrow Transplantation 2009; 43: 481-489
  41. Hamladji RM, Benakli M, Nacer RA, Talbi A ; Akhrouf S, Amer NA, Tensaout F, Harièche F, Belhadj R, Mehdid M, Rahmoune N, Zerhouni F. L'autogreffe de cellules souches hématopoïétiques après intensification thérapeutique dans le Myélome Multiple. À propos de 176 cas (1999-2011). Revue Algérienne d'hématologie 2013 ; 8 : 47-50
  42. Bekadja MA, Brahimi M, Osmani S, Arabi A, Bouhass R, Yafour N, Entasoltan B, Rasheed W, Attaf F. A simplified method for autologous stem cell transplantation in multiple myeloma. HematolOncol Stem Cell Ther 2012; 5(1): 49-53