Plasmapheresis in treatment of patients with newly diagnosed multiple myeloma complicated by hyperproteinemia: a single-center experience

Background. Multiple myeloma is often accompanied by the development of hyperproteinemia, an increased level of pathological protein in blood serum resulting from excessive secretion of free light chains or immunoglobulins by clonal plasma cells. Hyperproteinemia is associated with life-threatening complications such as hyperviscosity syndrome, cryoglobulinemia, impaired renal dysfunction, and coagulation disorders. Рlasmapheresis (PF) sessions are among the methods used to rapidly reduce the level of paraprotein in the blood serum.
Aim. To analyze the treatment results of newly diagnosed multiple myeloma (NDMM) patients complicated by hyperproteinemia who underwent PF. Materials and methods. We analyzed the data of 32 patients with NDMM patients who underwent PF and received complex therapy at the N.N. Blokhin National Medical Research Center of Oncology in the period from January 2000 to December 2020.
Results. Indications for PF included hyperviscosity syndrome in 3 (9.4 %) patients and serum total protein levels exceeding 120 g/L in 29 (90.6 %) patients. The median number of PF sessions performed was 3 (range 1–11). As induction therapy, 16 (50 %) patients received bortezomib-based regimens: VCP (bortezomib + cyclophosphamide + prednisolone) – 3 (9.3 %) patients, VCD (bortezomib + cyclophosphamide + dexamethasone) – 12 (37.6 %) patients, and VMP (bortezomib + melphalan + prednisolone) – 1 (3.1 %) patient. Another 16 (50 %) patients received chemotherapy regimens such as CP (cyclophosphamide + prednisolone) – 3 (9.3 %) patients, VAD (vincristine + doxorubicin + prednisolone) – 9 (28.2 %) patients, and VMCP (vincristine + melphalan + cyclophosphamide + prednisolone) – 4 (12.5 %) patients. Overall response rate was achieved in 18 (56.2 %) patients.
Of the 32 patients included in the study, 27 (84.4 %) were younger than 65 years and formally eligible for high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT). Auto-HSCT was performed in 12 (44.4 %) patients. After auto-HSCT, improvement of hematologic response was observed in 8 (66.8 %) patients: 2 (16.6 %) patients with very good partial response and 1 (8.3 %) patient with partial response achieved complete response, while 5 (41.7 %) patients with partial response reached very good partial response. With a median follow-up of 26.5 months (95 % confidence interval (CI) 1–119 months), median progression-free survival was 36 months (95 % CI 15–56 months), and median overall survival was 73 months (95 % CI 15–109 months). Multivariate analysis revealed statistically significant effects of the presence of bone plasmacytomas on progression-free survival (hazard ratio (HR) 0.090; 95 % CI 0.018–0.466; p = 0.004) and overall survival (HR 0.111; 95 % CI 0.024–0.517; p = 0.005), as well as the type of chemotherapy regimen administered on progression-free survival (HR 6.426; 95 % CI 1.075–38.433; p = 0.041) and age on overall survival (HR 0.072; 95 % CI 0.006–0.798; p = 0.032).
Conclusion. The use of plasmapheresis combined with bortezomib-based induction therapy in NDMM patients and hyperproteinemia effectively reduces the level of pathological protein and stabilizes the patientsʼ condition. PF decreases the risk of severe complications associated with hyperviscosity syndrome, allowing the safe administration of full-dose induction therapy.

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