Safety and survival outcomes for bloodless transplantation in patients with myeloma

High‐dose therapy (HDT) and autologous stem cell transplantation (ASCT) are established components in the treatment of multiple myeloma; however, undergoing transplantation usually requires hematopoietic support, which poses a challenge among patients who are unwilling to receive blood products. Most transplant centers decline HDT/ASCT to these patients because of safety concerns. Here, the authors' institutional data on safety, engraftment parameters, and survival outcomes after bloodless ASCT (BL‐ASCT) are examined among patients with myeloma. This retrospective case‐control study included patients who underwent BL‐ASCT and Transfusion‐supported ASCT (TS‐ASCT) at Emory University Hospital between August 2006 and August 2016. In total, 24 patients who underwent BL‐ASCT and 70 who underwent TS‐ASCT were included. The median time for neutrophil engraftment, platelet engraftment and the median length of hospital stay all were equivalent for both groups. There were no transplant‐related cardiovascular complications or mortality in either the BL‐ASCT group or the TS‐ASCT group. The median progression‐free survival was 36 months and 44 months in the BL‐ASCT and TS‐ASCT groups, respectively (P = .277), and the median OS was not reached in either group at a median follow‐up of 59 months after ASCT (P = .627). There was no transplant‐related mortality at the 100‐day or 1‐year mark in either group. BL‐ASCT is safe and feasible; transplant‐related mortality, cardiovascular and hematologic complications are similar to those associated with TS‐ASCT. Furthermore, BL‐ASCT can yield similar engraftment and survival parameters comparable to those observed with TS‐ASCT.

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