Evaluating the Effect of High Dose Chemotherapy and Autologous Bone Marrow Transplantation (ASCT) on Hypertension (HTN) in Multiple Myeloma (MM) Patients

Field: Medicine (Health Sciences)

A recent study showed that ASCT may reverse kidney failure in one third of multiple myeloma patients, which can lead to improvement in blood pressure. However, there is very limited published data studying the impact of the treatment on blood pressure control. We conducted a review of electronic medical records of 184 patients with established diagnosis of MM that underwent an ASCT at Karmanos Cancer Institute between January 1st, 2009 and December 31st, 2010. We recorded data that includes blood pressure (BP) readings 4 weeks before the transplant and then at days 0, 30,100 and 180. Other data includes GFR which is calculated by using the Cockcroft Gault formula at the same intervals, sub-type of MM and Durie-Salmon stage at diagnosis, disease response to therapy, BMI at baseline; and other comorbidities such as diabetes, hyperlipedemia and coronary artery disease. Statistical analyses were performed using the statistical package of SPSS version 18. All P-values were 2-sided. In this study 184 patients were included. The sample demographics at baseline are presented in Table 1. Association between BP stages and disease status before ASCT and at day 0 was statistically significant (p=.025 , X2 =14.408); there was no statistically significant association between stages of HTN at 0 , 30, 100 and 180 days after the ASCT in regards to age , race or gender. Mean Systolic and diastolic BP-value showed no statistically significant difference at the same intervals respectively. In addition, there was no correlation between stages of HTN, and stages or type of MM. The only statistically significant association between chronic kidney disease (CKD) stages and BP stages was at day 0 (day ASCT infused) (P=.032, X2 =26.670. The association between CKD stages and disease status at 100 days after melphalan was statistically significant (P=.043, X2 =25.568). The associations between BP stages and BMI stages were borderline or statistically significant at 30 days (P=.054 and X2=16.665), 100 days (P=.026 and X2=18.947) and 180 days(P=.001, X2=27.120). There was no direct effect of ASCT on blood pressure improvement. Other factors such as BMI and disease status at baseline appear to play more roles on Bp control. Majority of our patient were transplanted at early stages of (CKD) which can explain the result. We suggest a prospective study that evaluates the impact of ASCT in MM patients with high BP.Table 1Demographic characteristics of the simplePatient CharacteristicsNumber (%)Gender Male100 (54%)Median age years (range)59 (33-73)Race White138 (75%) African-American41 (22%) Other5 (3%)Marital status Never married18 (10%) Now married127 (69%) Separated13 (7%) Widowed6 (3%) Divorced20 (11%)Health insurance Medicare180 (98%) Other4 (2%)BMI Normal42 (23%) Overweight64 (35%) Obese42 (23%) Severely obese36 (19%)BP stage Normal32 (17%) Prehypertension78 (43%) Stage 1 HTN64 (35%) Stage 2 HTN19 (5%)CKD stage 160 (33%) 282 (45%) 3A24 (13%) 3B10 (5%) 45 (3%) 53 (1%)Myebma stage IA17 (19%) IIA25 (14%) IIIA130 (71%) IIIB12 (6%)Disease status VGPR65 (35%) PR57 (31%) CR26 (14%) SD18 (10%) PD16 (9%) SCR2 (1%)Melphalan dose 200 mg140 (76%) 140 mg44 (24%) Open table in a new tab