Is Bloodless Transplant Feasible in Multiple Myeloma?

Undergoing bloodless autologous stem cell transplantation (BL-ASCT) was a viable option for patients with multiple myeloma who were unwilling to receive blood products, according to a single-center retrospective study. These patients had outcomes similar to patients who underwent transfusion-supported ASCT (TS-ASCT).

“Although retrospective analyses have inherent limitations, and not all confounding variables can be accounted for, our results clearly demonstrate that BL-ASCT can be done safely,” Nisha S. Joseph, MD, of Winship Cancer Institute, Emory University, and colleagues wrote in Cancer.

According to the study, use of high-dose therapy (HDT) with ASCT improves progression-free survival (PFS) and overall survival (OS) for patients with myeloma. However, most centers do not offer HDT and HSCT to patients who decline blood products “because of safety concerns associated with a presumption of increased cardiovascular and bleeding complications and thus higher transplant-related mortality (TRM).”

Joseph and colleagues conducted this case-control study looking at 24 patients who underwent BL-ASCT and 70 patients who underwent TS-ASCT at Emory University Hospital between 2006 and 2016. The center uses a specific protocol designed to support patients’ hematologic requirements without transfusions.

“A goal of hemoglobin > 11 g/dL was attained before patients were admitted for transplantation, and blood loss was minimized using pediatric tubes and by limiting laboratory draws to twice weekly,” the researchers wrote. “Additional supportive measures (using aminocaproic acid, erythropoietin-stimulating agents, iron supplementation, proton pump inhibitors, and suppression of menses in women at risk, etc.) were also incorporated into patient care.”

The median time for neutrophil engraftment (12 days for both), platelet engraftment (13.5 vs 14 days), and median length of hospital stay (15.5 vs 16 days) were equivalent for the BL-ASCT and TS-ASCT groups of patients.

No transplant-related cardiovascular complications or mortality occurred in either group.

PFS and OS were also similar between the two groups. The median PFS was 36 months for BL-ASCT and 44 months for TS-ASCT. The median OS has not been reached for either group with a follow-up of almost 5 years.

Together these findings suggest “that BL-ASCT should be offered to appropriate transplant-eligible candidates.”

The researchers also noted that although they did not perform a cost-effectiveness analysis, BL-ASCT would likely be more cost effective because there is an absence of transfusion-related costs with similar length of stay, engraftment parameters, TRM, and cardiac complications.