Autologous/Allogeneic Hematopoietic Cell Transplantation versus Tandem Autologous Transplantation for Multiple Myeloma: Comparison of Long-Term Postrelapse Survival
Year: 2017
Type: article
Study design: Observational Study
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.
Authors: Myo Htut, Anita D'Souza, Amrita Krishnan, Benedetto Bruno, Mei-Jie Zhang, Mingwei Fei, Miguel Angel Diaz, Edward Copelan, Siddhartha Ganguly, Mehdi Hamadani, Mohamed Kharfan-Dabaja, Hillard Lazarus, Cindy Lee, Kenneth Meehan, Taiga Nishihori, Ayman Saad, Sachiko Seo, Muthalagu Ramanathan, Saad Z. Usmani, Christina Gasparetto, Tomer M. Mark, Yago Nieto, Parameswaran Hari
Institutions: City Of Hope National Medical Center, City of Hope, Medical College of Wisconsin, University of Turin, Hospital Infantil Universitario Niño Jesús, Carolinas Healthcare System, Levine Cancer Institute, University of Kansas Medical Center, Moffitt Cancer Center, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, University Hospitals Seidman Cancer Center, Royal Adelaide Hospital, Dartmouth–Hitchcock Medical Center, University of Alabama at Birmingham, National Cancer Center Hospital East, UMass Memorial Medical Center, Duke Medical Center, University of Colorado Anschutz, The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
Funders: U.S. Department of Defense, U.S. Department of Health and Human Services, Amgen, GlaxoSmithKline, Sanofi, WellPoint, Teva Pharmaceutical Industries, Ariad Pharmaceuticals, Celgene, HistoGenetics, Osiris Therapeutics, Tarix Pharmaceuticals, Therakos, University of Minnesota, Blue Cross and Blue Shield Association, StemCyte, Medical College of Wisconsin, Sigma-Tau Pharmaceuticals, Actinium Pharmaceuticals, Incyte, Otsuka America, Kiadis Pharma, Swedish Orphan Biovitrum, Medac, Health Resources and Services Administration, Genentech, Onyx Pharmaceuticals, U.S. Navy, Allos Therapeutics, Takeda Oncology, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases
OpenAlex ID: W2765918174