Tandem autologous stem cell transplantation improves outcomes in newly diagnosed multiple myeloma with extramedullary disease and high-risk cytogenetics: a study from the chronic malignancies working party of the European society for blood and marrow transplantation
Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for p...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
6 July 2019
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| In: |
Biology of blood and marrow transplantation
Year: 2019, Volume: 25, Issue: 11, Pages: 2134-2142 |
| ISSN: | 1523-6536 |
| DOI: | 10.1016/j.bbmt.2019.07.004 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1016/j.bbmt.2019.07.004 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S1083879119304367 
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| Author Notes: | Nico Gagelmann, Diderik-Jan Eikema, Linda Koster, Denis Caillot, Pietro Pioltelli, Juan Bargay Lleonart, Péter Reményi, Didier Blaise, Nicolaas Schaap, Marek Trneny, Jakob Passweg, Rocio Parody Porras, Jean Yves Cahn, Maurizio Musso, Xavier Poiré, Roland Fenk, Maija Itälä-Remes, Vincenzo Pavone, Loic Fouillard, Johan Maertens, Dominique Bron, Anastasia Pouli, Wilfried Schroyens, Stefan Schönland, Laurent Garderet, Ibrahim Yakoub-Agha, Nicolaus Kröger |
| Summary: | Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n=373), tandem autologous (n=84), or autologous-allogeneic transplant (n=31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n=202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous-allogeneic (P=.06 and P=.30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR], 2.00; P=.003), whereas tandem autologous significantly improved outcome versus single autologous transplant (HRs, .46 and .64; P=.02 and P=.03). Autologous-allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, .31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis. |
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| Item Description: | Gesehen am 23.01.2020 |
| Physical Description: | Online Resource |
| ISSN: | 1523-6536 |
| DOI: | 10.1016/j.bbmt.2019.07.004 |