Untersuchung zur Remissionstiefe von transplantationsfähigen Patienten mit multiplem Myelom nach Erstlinieninduktionstherapie – eine retrospektive Kohortenanalyse

The introduction of new agents in the treatment of Newly Diagnosed Multiple Myeloma (NDMM) has significantly improved the prognosis and outcome of patients eligible for transplantation. Increasingly, patients are treated within clinical trials, which usually involves therapy in clinical centres or teaching hospitals. The objective of this work was to find out whether the teaching status of the hospital has an impact on remission and stem cell apheresis in myeloma patients. We examined data from 184 myeloma patients who had received their first autologous stem cell transplant at the Universitätsklinikum Gießen und Marburg, Marburg site (UKGM) between 2012 and 2020. The patients were divided into 3 cohorts according to the site where the induction therapy was performed: UKGM, Teaching-hospital Fulda and referring physicians from the SHI system, so-called "office-based physicians". In addition, we compared patients who had received their induction therapy within a clinical trial with patients who had not been included in any clinical trial. We examined the remission status after receiving induction therapy and before stem cell transplantation, as well as the number of stem cells collected. The patients in the UKGM group showed significantly lower remissions than those in the other two cohorts. Since clinical trials were increasingly conducted at the university institute, while the patients of the two referral cohorts received induction therapy outside of such studies, with one exception, we attribute this observation primarily to the use of more aggressive agents. This can also be confirmed by the fact that comparing patients with and without clinical trials within the UKGM cohort, a significant difference in the depth of remission was detectable. When the patients with clinical trials were excluded, there was no longer any evidence of siginificance between the UKGM group and the other two cohorts. The overall population showed a tendency towards deeper remissions over the study period, which could also be observed when considering trial patients and patients without clinical trial separately. We attribute this to the fact that the therapy regimens have also generally become more aggressive. The amount of collected stem cells at the UKGM was between the numbers of the two other cohorts. However, trial patients showed a significantly lower amount of collected stem cells than patients without clinical trial. Over the period considered, the average number of CD34+ cells collected in the total cohort has approximately halved. This leads to the observation that remission status and stem cell apheresis are moving in opposite directions due to the increasing use of new agents.