Publication Date:
2011-11-18
Description:
Abstract 5073 Introduction Despite improvement in patient (pt) outcomes in recent years, multiple myeloma (MM) remains incurable and nearly all pts relapse after initial response to therapy. With disease progression and cumulative exposure to chemotherapeutic agents, pts with relapsed MM frequently develop cytopenias that represent a significant clinical challenge. At present, management of high-grade thrombocytopenia at our institution consists of supportive platelet transfusions. We hypothesize that thrombocytopenia is a highly relevant variable in the overall management of relapsed MM. As there are currently no studies in the myeloma literature that assess the impact of thrombocytopenia, we conducted a retrospective, chart-review study to evaluate the impact of thrombocytopenia in relapsed MM. Methods Participants included all pts with relapsed and/or relapsed-refractory MM who participated in clinical trials at Dana Farber Cancer Institute from January 1, 2007 – December 31, 2009. Many pts participated in more than one clinical trial during this time period. In this analysis, therapy administered to a particular patient in the context of one clinical trial is referred to as a “treatment regimen.” The overall incidence of thrombocytopenia (platelet count 〈 150,000/mcl) at initiation of a treatment regimen was recorded. The incidence of severe thrombocytopenia (platelet count 〈 100,000/mcl and 〈 75,000/mcl) was also determined. Medical record data collected to assess the clinical impact of thrombocytopenia included the following variables: episodes of ≥ grade 3 thrombocytopenia, number of platelet transfusions per pt per month on clinical trial, treatment delays and treatment discontinuations due to thrombocytopenia, the occurrence of bleeding events, and overall survival on clinical trial therapy. Point estimates with exact binomial confidence intervals and median and range are used to describe the data. The differences in platelet transfusion requirements were assessed by the two-sided Wilcoxon rank sum test. Results To date, data has been abstracted on 43 treatment regimens in 23 pts. Fifteen pts had previously undergone autologous stem cell transplantation (ASCT), including two who had undergone tandem auto-transplant. The overall incidence of thrombocytopenia (platelet count 〈 150,000/mcl) was 40% at time of treatment initiation. In 13 of the 43 (30%, 90% Confidence Interval (CI)) treatment regimens, the platelet count at time of treatment initiation was less than 100,000/mcl. The platelet count at time of treatment initiation was less than 75,000/mcl in 11 of 43 (25%, 90%CI) treatment regimens reviewed. Cases where the platelet count was ≤ 100,000/mcl at time of study entry, mean platelet transfusion requirement per 4-week time interval was 2.35 units, while in cases where the platelet count was ≥ 100,000/mcl, the mean platelet transfusion requirement was 0.20 units transfusions per 4 week period was needed (p
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
Permalink