P-419: Successful Pregnancy outcome and CR 4 transplant in a patient of Multiple myeloma

Introduction: Multiple myeloma is a disease of elderly, but young myeloma is not rare in India. Though infertility is a major concern with ASCT, Women with childbearing age group has successful pregnancy outcome post-transplant. Here we report a case of young myeloma with 2 successful pregnancy outcomes.

Methods: we retrospectively collected the data from hospital information system (HIS)

Results: A 44 years old female, who initially presented to our department in 2009 with severe backache and fatigue which was present since a year. She also had history of previous two MTP in view of non-viable fetus and history of spontaneous abortion of twin pregnancy. Initial lab analysis were suggestive of severe anemia (hemoglobin 8g/dl) and further work-up revealed the presence of M band of 5.7 g/dl and monoclonal IgG kappa immunoglobulin was detected by serum immunofixation electrophoresis while bone marrow examination showed 60% atypical plasma cells. Thus diagnosis of Multiple myeloma was confirmed and she was initiated on VAD chemotherapy regime (V=Vincristine, A=Adriamycin, D=Dexamethasone). After 6 cycles, complete remission was achieved and she was shifted to Thalidomide-dexamethasone maintenance followed by single agent thalidomide. In January 2012 she presented with amenorrhea for 3 months, pregnancy was confirmed on ultrasonography and no anomalies were detected in the fetus. As patient opted to continue with pregnancy, thalidomide was stopped and she was followed up at regular intervals. Her disease continued to be in remission during her pregnancy. At 37 weeks of gestation, she had spontaneous vaginal delivery and delivered a normal healthy female baby. She was thus put on close follow up after delivery and her disease continued to be in remission for next five years. In 2017, she again presented with severe anemia and was found to have relapse of Multiple myeloma. She was treated with bortezomib-thalidomide-dexamethasone, VGPR was attained and subsequently thalidomide maintenance was continued. In 2019, her disease again relapsed for which she was initiated on carfilzomib-pomalidomide-dexamethasone and VGPR was attained after 5 cycles. On both the previous occasion, she did not opt for autologous transplant. In June 2022, she again presented with severe anemia and a 3 rd relapse of multiple myeloma was Confirmed. Cytogenetics revealed ultra-high-risk features with detection of IgH rearrangement, TP53 deletion, gain 1q, deletion 1p. She was started on carfilzomib-pomalidomide-dexamethasone, after 6 cycles VGPR was attained which was then consolidated with autologous transplantation. Currently, she is day+350 post HSCT and continues to be in complete remission with MRD negative.

Conclusions: Infertility is a major concern by ASCT, for reproductive age group. Late ASCT can be considered for young female with myeloma.