Vergleich der hämatopoetischen Rekonstitution und der Supportivtherapie nach erster und zweiter Hochdosischemotherapie und autologer Blutstammzelltransplantation bei Patienten mit Multiplem Myelom

Purpose: We evaluated haematopoietic reconstitution including engraftment of white blood cells (WBC) and platelet cells (PLT) and supportive care requirements including red blood cell concentrates (RBCC), single-donor platelet concentrates (PLTC), antibiotical and antifungal treatment, as well as hospital stay and fever days in patients undergoing autologous transplantation after tandem highdose chemotherapy by multiple myeloma. Methods: Patients (n=44, 19 women, 25 men) suffering multiple myeloma (28 stage III, 14 stage II, 2 stage I by Durie and Salmon) underwent tandem HDCT/ASCT. We determined the days of engraftment of WBC and PLT as well as the number of transfused RBCC and PLTC, the number of patient-days on intravenous (i.v.) antibiotics and i.v. antifungals, as well as the length of hospital stay and fever days during the transplantation (time from HDCT/ASCT until discharge from hospital). Results: Patients with median age of 55 years (range:38-65) at the time of diagnosis received predominantly (72%) VAD (Vincristin/Adriamycin/Dexamethasone) as induction chemotherapy. The period from time to diagnosis to mobilisation amounted to 6 month. Mobilisation was conducted with highdose-cyclophosphamid in a median dosage of 2,0 g/m² (0,4-4,0), during leukapheresis in the median after 12 days (9-18) CD34+-cells was overall collected in median 8,8x10hoch 6/kg (3,1-34,0). After completion of the tandem highdose chemotherapy with a median dosage of 200 mg (100-200) melphalan CD34+-cells were in a median dose of 5,2x10 hoch 6/kg (2,5-25,0) at the first and in a median dose of 4,6x10 hoch 6/kg at the second HDCT/ASCT injected. During the posttransplantation course there was no significant difference between both groups concerning the engraftment of WBC (median: 13 (range: 8-24) vs. 12 (9-39); p=0.30) and PLT (median: 13 (8-26) vs. 14 (8-22); p=0.14). Concerning the number of transfused RBCC (median: 2 (0-8) vs. 0 (0-12); p=0.83) and the number of transfused PLTC (median: 1(0-11) vs. 1 (0-12); p=0.90) were not significantly different. All the same was valid on i.v. antibiotics (median: 8 days (0-26) vs. 7 days (0-47); p=0.80)) and on i.v. antifungals [median: 19 days (5-30) vs. 20 days (10-35); p=0.24). The difference between both groups regarding to fever days was not significant (median: 2 (0-8) vs. 1 (0-12); p=0.54) Hospital stay, however, was not significantly different between both groups (median: 21 days (16-30) vs. 21 days (12-47); p=0.90). Conclusion: The comparison of haematopoietic reconstitution and supportive care requirements following tandem HDCT/ASCT by multiple myeloma shows no significant difference.