Отдельные аспекты лечения пациентов с множественной миеломой с применением аутотрансплантации стволовых клеток

Abstract

The effectiveness of multiple myeloma (MM) patients’ treatment is dependent in particular on the depth of response after autologous stem cell transplantation (аutoHSCT). The importance of predictors associated with the quality of response after аutoHSCT is due to the possibility of changing the intensity of some stage of transplantation. The aim of the study was to determine the incidence of cases without the improvement of response depth after autoHSCT and to evaluate the distribution of genotype of a number of genes and status of hemopoietic niche cells as a possible predictor of аutoHSCT effectiveness in MM patients. Retrospective analysis of 84 MM patient’s data was carried out. Total number of transplants performed was 112 including 84 first and 28 second transplants. The response was determined according to IWG criteria. Status of hemopoietic niche cells was evaluated by histological, immunohistochemistry and morphometric methods. Improvment of the response depth after the first аutoHSCT was recorded in 29 (54.7%) patients. Similar events were higher in the patients with previous VGPR: 57.9% vs 18.2% in patients with PR; p=0.005. There was no difference in other clinical and hematologic parameters between the groups. After the second аutoHSCT the variant of response did not change in 4 out of 6 patients. The deepening of response occurred significantly more often in cases with more cells localized on endost; p=0.038. The results of bone marrow trepanobiopsy can be considered as predictors of a possible improvement in the quality of response or lack thereof in patients with MM after performing аutoHSCT.