Blood Product Support in Multiple Myeloma Patients Undergoing Autologous Bone Marrow Transplantation May Predict Improved Outcome.

Introduction Patients with multiple myeloma (MM) who received autologous bone marrow transplantation (ABMT) may require transfusion of packed red blood cells (pRBCs) and platelets (Plt). Transfusion independency may serve as a useful prognostic factor for bone marrow health. In this study, we observed the post ABMT outcomes in relation to the number of pRBC and Plt transfusions during post-transplant hospital stay. Methods We have summarized the results in 330 patients with MM who received post-transplant pRBCs and/or Plt transfusion during transplant admission. After exclusion of the second transplant of the patients who received a second ABMT (n=26), patients on hemodialysis (n=24), patients who did not have Complete Remission (CR)/Partial Remission (PR)/Very Good Partial Remission (VGPR) (n=80), patients who received more than one treatment before transplant (n=76), admission hemoglobin ≤ 9 or Plt ≤50 (n=10), or Jehovah Witness (n=5), we considered 132 patients for the analysis. We investigated whether higher quantities of pRBCs and/or Plt transfusion predicts poorer outcomes in terms of Progression Free Survivor (PFS), Overall Survivor (OS), and relapse during follow up. We divided the total number of transfusions for PRBCs or Plt transfusions in two groups: Group-1 patients with 0 or 1 transfusion and Group-2 patients with more than 1 transfusions. The number of transfusions has been categorized instead of continuous variable to avoid skewing data due to refractory platelet transfusion. Results The median age of the patient at transplant was 62 years (range 33-77); 62% of patients were male and 55% were White. The median OS from transplant was 1132 days (range 16-8750) and OS frequency greater than 1 year after transplant was 95%. The median PFS since transplant was 956 days (range 16-8750). Post-transplant OS for Plt Gr-1 was 971 days (range 88-3697) and for Plt Gr-2 was 1494 days (range 16-8750) (p=0.009). Post-transplant PFS in Plt Gr-1 was 846 days (range 88-3697) and in Plt Gr-2 was 1121 days (range 16-8750) (p=0.04). OS greater than 1 year following transplant was 59% in Plt Gr-1 and 66% in Plt Gr-2 (p=0.43). Median post-transplant OS in pRBC Gr-1 was 1007 days (range 88-3063) and in pRBC Gr-2 was 1573 days (range 16-8750) (p=0.003). Post-transplant PFS in pRBC Gr-1 was 907 days (88-3063) and in pRBC Gr-2 was 1125 days (range 16-8750) (p=0.26). OS greater than 1-year post-transplant was 76% in pRBC GR-1 and 49% in pRBC Gr-2 (p=0.41). Conclusion Our study shows that higher Plt transfusions during post-ABMT hospitalization predicts higher PFS and OS. Higher pRBC transfusions also predicts better survival. Frequency of survival and PFS at greater than 1 year did not significantly change between lower and higher quantities of either pRBC or Plt blood product support.