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Khan AM, Ozga M, Bhatt H, Faisal MS, Ansari S, Zhao Q, Bumma N, Cottini F, Devarakonda S, Rosko A, Sharma N, Umyarova E, Benson D. Outcomes After Salvage Autologous Hematopoietic Cell Transplant for Patients With Relapsed/Refractory Multiple Myeloma: A Single-Institution Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e182-e189. [PMID: 36581554 DOI: 10.1016/j.clml.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of salvage autologous hematopoietic cell transplantation (sAHCT2) for patients with relapsed/refractory multiple myeloma (RRMM) in the era of modern therapeutics is unclear. As prospective data is limited, we conducted a retrospective analysis to determine the outcomes of sAHCT2. PATIENTS AND METHODS We conducted a single-institution, retrospective analysis of patients who received sAHCT2 at The Ohio State University from 2000 to 2018. Patients who received a second transplant as part of a planned tandem or autologous-allogeneic transplant were excluded. RESULTS Fifty-seven patients were treated with sAHCT2. Patients had a median of 2 lines of therapy after AHCT1 prior to their sAHCT2; 70% had prior immunomodulatory imide drugs, 82% had prior proteasome inhibitor, and 20% had prior anti-CD38 monoclonal antibodies as part of re-induction therapy. Forty-two percent of patients attained ≥VGPR prior to sAHCT2. Seventy-four were treated with melphalan 200 mg/m2 as conditioning regimen before infusion of a median of 3.8 × 106 CD34+ cells/kg. Fifty-eight percent patients had maintenance therapy and 81% patients attained CR/VGPR as the best response after sAHCT2. The median PFS and OS after sAHCT2 were 1.6 and 3.6 years, respectively. On multivariable analysis, high-risk cytogenetics, not having attained CR/VGPR, and having more than 2 lines of therapy post-AHCT1 were associated with inferior PFS. Melphalan 140 mg/m2 compared to melphalan 200 mg/m2 and no maintenance therapy compared to maintenance therapy were not associated with inferior PFS. There was no transplant-related mortality in this patient cohort. CONCLUSIONS For MM patients deriving durable remission after their AHCT1, sAHCT2 was safe and resulted in deep and durable remissions.
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Affiliation(s)
- Abdullah M Khan
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Michael Ozga
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Harshil Bhatt
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Muhammad S Faisal
- Roswell Park Comprehensive Cancer Center, Division of Hematology, Rochester, NY
| | - Sadia Ansari
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Francesca Cottini
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Srinivas Devarakonda
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ashley Rosko
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nidhi Sharma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Elvira Umyarova
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Don Benson
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
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Post Salvage Therapy Autologous Transplant for Relapsed Myeloma, Ongoing Relevance within Modern Treatment Paradigms? CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e97-e106. [PMID: 36564313 DOI: 10.1016/j.clml.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Salvage transplant has been historically considered effective therapy for myeloma patients relapsing after first transplant, if they achieved adequate remission duration. However, the efficacy of novel agent combinations has called this paradigm into question. MATERIALS AND METHODS We performed a retrospective analysis in a homogeneously treated cohort of 106 patients undergoing ASCT2 at our institution, all of whom received novel agent-based chemotherapy (immunomodulatory agent [IMiD] and/or proteasome inhibitor [PI]) for both induction and relapse. As an exploratory objective we assessed whether predictive thresholds of progression free survival post first transplant (ASCT1) for benefit post ASCT2 vary with use of IMiD maintenance post ASCT1. RESULTS The overall response rate (ORR) was 98% post-ASCT2 and treatment-related mortality (TRM) was low at 1.8%. With a median follow-up of 26 months (range 0.5-85) from ASCT2, median overall survival (OS) is estimated at 80 months (95% CI: ≥ 49-months) and median progression-free survival after ASCT2 (PFS2) at 24 months (95% CI 19-39). PFS post first transplant (PFS1) at >/= 50 months was associated with improved OS. Predictors of PFS2 included PFS1 ≤42 months and progression on IMiD-based maintenance post- ASCT1. CONCLUSION ASCT2 continues to offer acceptable outcomes for most patients treated within modern day treatment paradigms, with longer PFS after ASCT1 and IMiD non-refractory disease being associated with improved outcomes.
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The first relapse in multiple myeloma: how to pick the next best thing. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:560-568. [PMID: 36485087 PMCID: PMC9821240 DOI: 10.1182/hematology.2022000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The choice of treatment for patients with multiple myeloma (MM) at first relapse/progression is based on many factors: (1) treatment-related factors, which include the regimen used during first induction, the quality and duration of first response achieved, toxicities from the first treatment, whether the patient underwent autologous stem cell transplant, and whether the patient was on maintenance at the time of relapse/progression; (2) disease-related factors, including disease presentation and pace of progression; and (3) patient-related factors, including functional age and performance status. The learning objectives are to present the treatment options for patients with MM upon their first relapse and to learn about various strategies for selecting an optimal treatment regimen.
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Salvage Autologous Stem Cell Transplantation in Daratumumab-Refractory Multiple Myeloma. Cancers (Basel) 2021; 13:cancers13164019. [PMID: 34439174 PMCID: PMC8392190 DOI: 10.3390/cancers13164019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Daratumumab, a CD38-targeting monoclonal antibody, has significantly improved survival rates in multiple myeloma (MM), yet patients who progress on Daratumumab have dismal clinical outcomes with an overall median of less than 10 months. While emerging novel modalities have shown promising results, the current study explores the use of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in heavily pretreated Daratumumab-refractory MM patients. We retrospectively investigated the outcome of 69 consecutive patients who received upfront ASCT. The median progression-free survival (PFS) for the entire patient cohort was 7.2 months with a median overall survival (OS) of 19.3 months. For patients with ≥very good partial response (VGPR), median PFS and OS improved to 9 months and 34 months, respectively. Achievement of MRD negativity in ≥VGPR did not further improve the outcome. A better performance status, younger age, longer time interval from initial MM diagnosis/initial ASCT to salvage ASCT and low-risk GEP70 were all associated with improved PFS and OS after salvage ASCT. Our results suggest a role for salvage ASCT in selected heavily pretreated and Daratumumab-refractory patients.
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Richards H, Chavda SJ, Wilson W, Camilleri M, Cohen O, Horder J, Newrick F, Papanikolaou X, Sive J, Lee L, Popat R, Wechalekar A, Kyriakou C, Yong K, Rabin N. Salvage second autologous stem cell transplant for relapsed multiple myeloma in the novel agent era benefits a subset of patients: single-center UK experience. Leuk Lymphoma 2021; 62:3544-3547. [PMID: 34348069 DOI: 10.1080/10428194.2021.1961240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huw Richards
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Selina J Chavda
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - William Wilson
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - Marquita Camilleri
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Oliver Cohen
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Jackie Horder
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Fiona Newrick
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Xenofon Papanikolaou
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Jonathan Sive
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Lydia Lee
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Ashutosh Wechalekar
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Charalampia Kyriakou
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
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Hagen PA, Stiff P. The Role of Salvage Second Autologous Hematopoietic Cell Transplantation in Relapsed Multiple Myeloma. Biol Blood Marrow Transplant 2019; 25:e98-e107. [DOI: 10.1016/j.bbmt.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
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