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Hematol Oncol. 2019 Oct 31. doi: 10.1002/hon.2688. [Epub ahead of print]

Comparison between autologous and allogeneic stem cell transplantation as salvage therapy for multiple myeloma relapsing/progressing after autologous stem cell transplantation.

Author information

1
Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan.
2
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
3
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
4
Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
5
Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Okayama, Japan.
6
Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan.
7
Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
8
Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
9
Department of Hematology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan.
10
Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan.
11
Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan.
12
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
13
Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan.
14
Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.
15
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan.
16
Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
17
Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
18
Department of Hematology/Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.

Abstract

Allogeneic stem cell transplantation (allo-SCT) offers a clinical option to young patients with multiple myeloma (MM) relapsing/progressing after autologous SCT (ASCT); however, this claim remains debatable. Thus, in this retrospective study, we analysed 526 patients with MM who underwent SCT for MM relapsing/progressing after the prior ASCT using the registry data of the Japan Society for Hematopoietic Cell Transplantation (2001-2015) and compared overall survival (OS) between allo-SCT (n = 192) and autologous stem cell retransplantation groups (ReASCT; n = 334) based on risk factor points. Significant adverse factors for OS in all patients were (1) male sex, (2) less than partial response to SCT, (3) performance status of 2-4 and (4) short duration from the prior ASCT. We scored factor (2) as 1 point, factor (3) as 2 points and factor (4) as 0, 1 or 2 points for >30, 9-30 or <9 months, respectively. We categorised patients into three risk subgroups based on their total points (0, 1-3 and 4-5 points), indicating the usefulness of this scoring system for prognosis prediction and treatment selection. Subgroup comparison revealed OS after ReASCT to be higher than that after allo-SCT in the intermediate-risk subgroup comprising the largest population (28.2% vs. 21.5%, P < 0.004). We observed no significant advantages of allo-SCT over ReASCT in the low- and high-risk subgroups. These findings suggest that ReASCT is more advantageous than allo-SCT in many patients with MM relapsing/progressing after the prior ASCT. However, long-term survival patients were noted only in the allo-SCT group, and allo-SCT could exhibit clinical efficacy, particularly in the low-risk group. While further examination is warranted, allo-SCT could be a potential tool for a specific population with MM relapsing/progressing after the prior ASCT.

KEYWORDS:

humans; multiple myeloma; prognosis; stem cell transplantation; treatment outcome

PMID:
31674032
DOI:
10.1002/hon.2688

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