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Biol Blood Marrow Transplant. 2018 Mar;24(3):478-485. doi: 10.1016/j.bbmt.2017.10.024. Epub 2017 Oct 24.

Autologous/Allogeneic Hematopoietic Cell Transplantation versus Tandem Autologous Transplantation for Multiple Myeloma: Comparison of Long-Term Postrelapse Survival.

Author information

1
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California.
2
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
4
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
6
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
7
Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas.
8
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
9
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
10
Division of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia.
11
Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
12
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
13
National Cancer Research Center, East Hospital Kashiwa, Chiba, Japan.
14
Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
15
Department of Hematology and Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
16
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
17
Division of Hematology, University of Colorado-Anschutz Medical College, Aurora, Colorado.
18
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
19
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: phari@mcw.edu.

Abstract

We compared postrelapse overall survival (OS) after autologous/allogeneic (auto/allo) versus tandem autologous (auto/auto) hematopoietic cell transplantation (HCT) in patients with multiple myeloma (MM). Postrelapse survival of patients receiving an auto/auto or auto/allo HCT for MM and prospectively reported to the Center for International Blood and Marrow Transplant Research between 2000 and 2010 were analyzed. Relapse occurred in 404 patients (72.4%) in the auto/auto group and in 178 patients (67.4%) in the auto/allo group after a median follow-up of 8.5 years. Relapse occurred before 6 months after a second HCT in 46% of the auto/allo patients, compared with 26% of the auto/auto patients. The 6-year postrelapse survival was better in the auto/allo group compared with the auto/auto group (44% versus 35%; P = .05). Mortality due to MM was 69% (n = 101) in the auto/allo group and 83% (n = 229) deaths in auto/auto group. In multivariate analysis, both cohorts had a similar risk of death in the first year after relapse (hazard ratio [HR], .72; P = .12); however, for time points beyond 12 months after relapse, overall survival was superior in the auto/allo cohort (HR for death in auto/auto =1.55; P = .005). Other factors associated with superior survival were enrollment in a clinical trial for HCT, male sex, and use of novel agents at induction before HCT. Our findings shown superior survival afterrelapse in auto/allo HCT recipients compared with auto/auto HCT recipients. This likely reflects a better response to salvage therapy, such as immunomodulatory drugs, potentiated by a donor-derived immunologic milieu. Further augmentation of the post-allo-HCT immune system with new immunotherapies, such as monoclonal antibodies, checkpoint inhibitors, and others, merit investigation.

KEYWORDS:

Allogeneic transplantation; Myeloma; Relapse; Survival

PMID:
29079457
PMCID:
PMC5826888
DOI:
10.1016/j.bbmt.2017.10.024
[Indexed for MEDLINE]
Free PMC Article

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