Reducing Symptom Burden in Older Patients with Multiple Myeloma (MM) Using Interleukin-6 (IL-6) Blockage Peri-Autologous Hematopoietic Stem Cell Transplantation (AHCT)

Abstract

Background For MM patients (pts), AHCT improves progression free and overall survival, but in older pts is often associated with significant symptom burden. IL-6 levels peak during count nadir when symptom burden also peaks. We aimed to improve symptom burden using siltuximab (anti-IL-6 antibody, Janssen) peri-AHCT. Methods Siltuximab was given at 11 mg/kg on day -7 and day +21 from AHCT. MD Anderson Symptom Inventory – MM was measured at baseline, day -2, +7, and +30. IL-6 and C-reactive protein (CRP) were measured at baseline, day -2, 0, +3, +7, +14, +21, and +30. Results Between 1/2018 – 8/2018, 14 pts (median age 65 (range 60-70), 7 female) were enrolled. One pt was removed from study after the day -7 siltuximab due to primary physician request as AHCT was delayed due to frailty and non-compliance. Results below are based on remaining 13 pts. Median HCT-CI was 1 (range 0-8, with 5 pts’ HCT-CI >2) and median KPS on day -2 was 80 (range 70-90). Two pts had mild infusion reactions, one with tingling of lips and one with hives which resolved with Benadryl. Neither had a reaction with the subsequent infusion. Neutrophil engraftment occurred at a median of 9 days (range 8-11), but 5 pts (38%) received at least one dose of filgrastim after engraftment. No pts had neutropenic fevers, but one pt developed a pneumonia requiring high-flow oxygen. Two pts (15%) had engraftment syndrome. CRP levels were elevated at baseline in 85% of pts with median level of 0.12 mg/dL (range Conclusion Siltuximab appears to decrease fatigue without delaying engraftment, but may delay full count recovery. No pts developed a neutropenic fever. Full interim analysis of MDASI-MM, IL-6, and CRP trends will be presented.