Division of Hematology and Oncology, Department of Medicine
Hematology | Hemic and Immune Systems | Hemic and Lymphatic Diseases | Neoplasms | Oncology
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.
Allogeneic transplantation, Myeloma, Relapse, Survival
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Author's submitted manuscript (preprint) posted as allowed by publisher's article sharing policy at: https://www.elsevier.com/about/our-business/policies/sharing.
DOI of Published Version
Biol Blood Marrow Transplant. 2018 Mar;24(3):478-485. doi: 10.1016/j.bbmt.2017.10.024. Epub 2017 Oct 24. Link to article on publisher's site
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Htut M, Ramanathan M, Hari P. (2018). Autologous/Allogeneic Hematopoietic Cell Transplantation versus Tandem Autologous Transplantation for Multiple Myeloma: Comparison of Long-Term Postrelapse Survival. Open Access Articles. https://doi.org/10.1016/j.bbmt.2017.10.024. Retrieved from https://escholarship.umassmed.edu/oapubs/3404
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