UMMS Affiliation

Division of Hematology and Oncology, Department of Medicine

Publication Date

2018-03-01

Document Type

Article Preprint

Disciplines

Hematology | Hemic and Immune Systems | Hemic and Lymphatic Diseases | Neoplasms | Oncology

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.

Keywords

Allogeneic transplantation, Myeloma, Relapse, Survival

Rights and Permissions

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

10.1016/j.bbmt.2017.10.024

Source

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

Journal/Book/Conference Title

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

Comments

Full author list omitted for brevity. For the full list of authors, see article.

Related Resources

Link to Article in PubMed

PubMed ID

29079457

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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