TY - JOUR
T1 - Long-Term Outcomes of Allogeneic Hematopoietic Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma
AU - Afrough, Aimaz
AU - Alsfeld, Leonard C.
AU - Milton, Denái R.
AU - Delgado, Ruby
AU - Popat, Uday R.
AU - Nieto, Yago
AU - Kebriaei, Partow
AU - Oran, Betul
AU - Saini, Neeraj
AU - Srour, Samer
AU - Hosing, Chitra
AU - Cheema, Faisal H.
AU - Ahmed, Sairah
AU - Manasanch, Elisabet E.
AU - Lee, Hans C.
AU - Kaufman, Gregory P.
AU - Patel, Krina K.
AU - Weber, Donna M.
AU - Orlowski, Robert Z.
AU - Pinnix, Chelsea C.
AU - Dabaja, Bouthaina S.
AU - Thomas, Sheeba K.
AU - Champlin, Richard E.
AU - Shpall, Elizabeth J.
AU - Qazilbash, Muzaffar H.
AU - Bashir, Qaiser
N1 - Publisher Copyright:
© 2022 The American Society for Transplantation and Cellular Therapy
PY - 2023/4
Y1 - 2023/4
N2 - Despite remarkable progress in survival with the availability of novel agents, an overwhelming majority of patients with multiple myeloma (MM) have disease that relapses. Allogeneic (allo-) hematopoietic cell transplantation (HCT) is a potentially curative option for a subgroup of patients with high-risk MM. This study assessed the long-term outcome of MM patients who underwent allo-HCT while in first remission as consolidation treatment. Thirty-three patients with newly diagnosed MM who underwent allo-HCT as part of consolidation therapy between 1994 and 2016 were reviewed retrospectively. Of these patients, 70% underwent autologous HCT before allo-HCT. All patients were chemosensitive and achieved at least partial response before proceeding to allo-HCT. Most received nonmyeloablative/reduced-intensity conditioning (88%) and a matched sibling donor graft (85%). Acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 30% and 61% of patients, respectively. The median duration of follow-up was 64.1 months (range, 1.4 to 199.2 months) for all patients and 164.4 months (range, 56.0 to 199.2 months) for survivors. The median progression-free survival (PFS) was 36 months (95% confidence interval (CI), 8.6 to 73.0 months). The median time from treatment to progression was 73.0 months (95% CI, 30.6 months to not reached). The median overall survival (OS) was 131.9 months (95% CI, 38.4 months to not reached). Of all patients, 39% were alive for more than 10 years, with 46% (n = 6) without progression or relapse. The cumulative incidence of relapse was 18% at 1 year, 39% at 5 years, and 46% at 10 years post-allo-HCT. The cumulative incidence of nonrelapse mortality was 3% at 100 days, 18% at 1 year, 21% at 3 years, and 24% at 5 year post-allo-HCT. On multivariable analysis, high-risk cytogenetics were associated with a shorter PFS (hazard ratio [HR], 2.7; 95% CI, 1.01 to 7.21; P =.047) and OS (HR, 4.91; 95% CI, 1.48 to 16.27; P =.009). Achieving complete remission after allo-HCT also was associated with longer PFS (HR, 0.24; 95% CI, 0.09 to 0.64; P =.004) and OS (HR,.23; 95% CI,.07 to.72; P =.012). Allo-HCT may confer a survival advantage in a selected population of MM patients when performed early in the disease course; additional data on identifying the patients who will benefit the most are needed.
AB - Despite remarkable progress in survival with the availability of novel agents, an overwhelming majority of patients with multiple myeloma (MM) have disease that relapses. Allogeneic (allo-) hematopoietic cell transplantation (HCT) is a potentially curative option for a subgroup of patients with high-risk MM. This study assessed the long-term outcome of MM patients who underwent allo-HCT while in first remission as consolidation treatment. Thirty-three patients with newly diagnosed MM who underwent allo-HCT as part of consolidation therapy between 1994 and 2016 were reviewed retrospectively. Of these patients, 70% underwent autologous HCT before allo-HCT. All patients were chemosensitive and achieved at least partial response before proceeding to allo-HCT. Most received nonmyeloablative/reduced-intensity conditioning (88%) and a matched sibling donor graft (85%). Acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 30% and 61% of patients, respectively. The median duration of follow-up was 64.1 months (range, 1.4 to 199.2 months) for all patients and 164.4 months (range, 56.0 to 199.2 months) for survivors. The median progression-free survival (PFS) was 36 months (95% confidence interval (CI), 8.6 to 73.0 months). The median time from treatment to progression was 73.0 months (95% CI, 30.6 months to not reached). The median overall survival (OS) was 131.9 months (95% CI, 38.4 months to not reached). Of all patients, 39% were alive for more than 10 years, with 46% (n = 6) without progression or relapse. The cumulative incidence of relapse was 18% at 1 year, 39% at 5 years, and 46% at 10 years post-allo-HCT. The cumulative incidence of nonrelapse mortality was 3% at 100 days, 18% at 1 year, 21% at 3 years, and 24% at 5 year post-allo-HCT. On multivariable analysis, high-risk cytogenetics were associated with a shorter PFS (hazard ratio [HR], 2.7; 95% CI, 1.01 to 7.21; P =.047) and OS (HR, 4.91; 95% CI, 1.48 to 16.27; P =.009). Achieving complete remission after allo-HCT also was associated with longer PFS (HR, 0.24; 95% CI, 0.09 to 0.64; P =.004) and OS (HR,.23; 95% CI,.07 to.72; P =.012). Allo-HCT may confer a survival advantage in a selected population of MM patients when performed early in the disease course; additional data on identifying the patients who will benefit the most are needed.
KW - Allogeneic hematopoietic stem cell transplantation
KW - Long-term outcome
KW - Multiple myeloma
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UR - http://www.scopus.com/inward/citedby.url?scp=85147594007&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2022.05.023
DO - 10.1016/j.jtct.2022.05.023
M3 - Article
C2 - 35605883
AN - SCOPUS:85147594007
SN - 2666-6367
VL - 29
SP - 264.e1-264.e9
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 4
ER -