Tandem Autologous Hematopoietic Stem Cell Transplantation in Very Young Patients with Multiple Myeloma.

Introduction  Multiple myeloma (MM) in very young patients is uncommon, and no treatment guidelines exist for these patients. Patients and Methods  We performed a retrospective analysis of five very young myeloma patients who underwent tandem autologous hematopoietic stem cell transplantation (HSCT). Results  The median age was 37 years (range = 34-40 years). A median of two leukapheresis was performed (range = 1-4). The median number of hematopoietic stem cells collected was 5.4 × 10 6 /kg (4.4-8.2 × 10 6 /kg). During first transplant, four patients received melphalan of 200 mg/m 2 and one patient received melphalan of 140 mg/m 2 (due to renal failure) as conditioning regimen. Second transplant conditioning was melphalan of 200 mg/m 2 for one patient and melphalan of 140 mg/m 2 for remaining four patients. Two patients were in complete remission, and two were in very good partial remission and one patient progressed to active disease at the time of tandem autologous bone marrow transplant. All patients developed significant mucositis. Neutrophil and platelet recovery was longer in tandem autologous hematopoietic stem cell transplant. More viral infections were seen in tandem transplant. Day 30 and day 100 mortality was nil. Conclusion  We present data on tandem autologous HSCTs in very young patients with MM in India. Responses continued to improve in this small series.