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Title
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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
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Author
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Abstract
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| 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 (NRs,.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. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. |
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Language
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English
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Source (journal)
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Biology of blood and marrow transplantation. - -
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Publication
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2019
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ISSN
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1083-8791
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DOI
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10.1016/J.BBMT.2019.07.004
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Volume/pages
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25
:11
(2019)
, p. 2134-2142
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ISI
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000500077400003
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Pubmed ID
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31288095
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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