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Biol Blood Marrow Transplant. 2018 Jul;24(7):1392-1398. doi: 10.1016/j.bbmt.2018.03.012. Epub 2018 Mar 16.

The Role of Allogeneic Transplantation for Multiple Myeloma in the Era of Novel Agents: A Study from the Japanese Society of Myeloma.

Author information

1
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
2
Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan. Electronic address: tsukada-imsut@umin.ac.jp.
3
Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan.
4
Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.
5
Department of Hematology/Oncology, Kurashiki Central Hospital, Okayama, Japan.
6
Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
7
Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan.

Abstract

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered a potentially curative therapy for patients with multiple myeloma, the role of allo-HSCT remains unclear in the novel agent era. We conducted a retrospective study of 65 patients with multiple myeloma who underwent allo-HSCT at 19 institutions from 2009 to 2016. Patients received a median of 3 (range, 1 to 7) lines of prior therapy, including at least 1 novel agent, except for autologous HSCT. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 18.8% (95% confidence interval [CI], 9.6% to 30.3%) and 47.2% (95% CI, 33.9% to 59.4%), respectively. In a multivariate analysis, an age ≥50 years and less than a very good partial response (VGPR) before allo-HSCT were independent significant adverse factors for PFS (hazard ratio [HR], 2.30, P = .0063; HR, 2.86; P = .0059) and OS (HR, 2.37, P = .013; and HR, 2.74; P = .040). In contrast, the 3-year PFS and OS rates in patients <50 years of age who achieved a VGPR or better before allo-HSCT were 64.3% (95% CI, 29.8% to 85.1%) and 80.2% (95% CI, 40.3% to 94.8%), respectively. The overall response rate was 86.4% (95% CI, 75.0% to 94.0%). The proportion of VGPR or better increased from 29% before allo-HSCT to 71% after allo-HSCT. The nonrelapse mortality at 3 years was 23.4% (95% CI, 13.8% to 34.4%). Only an age ≥50 years was associated with higher nonrelapse mortality (HR, 4.71; P = .015). We showed that allo-HSCT is feasible for heavily pretreated patients with multiple myeloma, even in the novel agent era. Allo-HSCT in particular is a promising therapy for young and chemosensitive patients.

KEYWORDS:

Allogeneic transplantation; Graft-versus-myeloma effect; Multiple myeloma; Novel agents

PMID:
29555314
DOI:
10.1016/j.bbmt.2018.03.012
[Indexed for MEDLINE]
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