MM-074 How can Different Therapeutic Strategies and Financial Resources Impact Outcomes After Autologous Stem Cell Transplantation in Myeloma? Study in France and Algeria

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 23; p. S474
• Main Authors: Martin, Emilie, Morisset, Stéphane, Sobh, Mohamad, Quillon, Alfred, Boyer, Hélène, Rey, Philippe, Virelizier, Emmanuelle Nicolas, Assaad, Souad, Belabri, Amine, Guillermin, Yann, Lebras, Laure, Mialou, Valérie, Bourgeot, Jean Paul, Teyssier, Mélinda, Brahimi, Mohamed, Osmani, Soufi, Amani, Kamila, Bouchama, Samira, Charef, Lila, Yafour, Nabil, Michallet, Anne Sophie, Bekadja, Mohamed-Amine, Michallet, Mauricette
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2023
• Subjects: autologous stem cell transplantation; long-term overall survival; neoplasia; MM; long-term overall survival; neoplasia; autologous stem cell transplantation
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)01403-9

Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal clonal plasma cell proliferation in the bone marrow secreting a monoclonal component. The international standard care for eligible patients consists of intensive induction therapy followed by high-dose melphalan and autologous stem cell transplantation (ASCT). Our study included two groups of newly diagnosed MM patients who received a first-line treatment of double or triple induction, ASCT, with or without consolidation and maintenance. The study participants were treated in Lyon (France) and Oran (Algeria). The principal aim of this study was to evaluate the long-term outcome after ASCT in these 2 countries with different resources and to evaluate the potential consequences of non-identical access to the same therapeutic arsenal and means of early detection of relapse. Despite important differences between the 2 countries, we showed a similar overall survival (OS) for the total population and patients who did not relapse and received no chemotherapy after ASCT. Surprisingly, these latter patients concerned 2/3 of Algerian patients and only 1/3 of French patients, explained by differences regarding the definition of relapse and leading to a probable underestimation in Algeria. To better explore this observation, we performed a survival analysis using the instant ratio. We found better survival in France between 0-12 months after ASCT, related to higher non-relapse mortality in Algeria. Furthermore, we showed better survival in Algeria after 48 months. This last result was enhanced by a significant difference in the time to next treatment (TTNT) between Algeria and France (median TTNT of 72.61 months and 32.77 months, respectively). For relapsing patients, we found a better OS in France for patients who received ≤3 lines of treatment after ASCT, and no difference between French patients who received ≥4 therapeutic lines and Algerian patients receiving 1 or 2 lines. In conclusion, waiting to re-treat MM patients in Algeria, correlated with delayed TTNT, could support the hypothesis of lower healthcare costs and therapeutic savings when comparing France and Algeria. This is strengthened by a similar global long-term OS of the 2 groups.