1
|
Hughes CFM, Shah GL, Paul BA. Autologous hematopoietic stem cell transplantation for multiple myeloma in the age of CAR T cell therapy. Front Oncol 2024; 14:1373548. [PMID: 38601770 PMCID: PMC11004402 DOI: 10.3389/fonc.2024.1373548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy has revolutionized the management of relapsed and refractory myeloma, with excellent outcomes and a tolerable safety profile. High dose chemotherapy with autologous hematopoietic stem cell transplantation (AHCT) is established as a mainstream of newly diagnosed multiple myeloma (NDMM) management in patients who are young and fit enough to tolerate such intensity. This standard was developed based on randomized trials comparing AHCT to chemotherapy in the era prior to novel agents. More recently, larger studies have primarily shown a progression free survival (PFS) benefit of upfront AHCT, rather than overall survival (OS) benefit. There is debate about the significance of this lack of OS, acknowledging the potential confounders of the chronic nature of the disease, study design and competing harms and benefits of exposure to AHCT. Indeed upfront AHCT may not be as uniquely beneficial as we once thought, and is not without risk. New quadruple-agent regimens are highly active and effective in achieving a deep response as quantified by measurable residual disease (MRD). The high dose chemotherapy administered with AHCT imposes a burden of short and long-term adverse effects, which may alter the disease course and patient's ability to tolerate future therapies. Some high-risk subgroups may have a more valuable benefit from AHCT, though still ultimately suffer poor outcomes. When compared to the outcomes of CAR T cell therapy, the question of whether AHCT can or indeed should be deferred has become an important topic in the field. Deferring AHCT may be a personalized decision in patients who achieve MRD negativity, which is now well established as a key prognostic factor for PFS and OS. Reserving or re-administering AHCT at relapse is feasible in many cases and holds the promise of resetting the T cell compartment and opening up options for immune reengagement. It is likely that personalized MRD-guided decision making will shape how we sequence in the future, though more studies are required to delineate when this is safe and appropriate.
Collapse
Affiliation(s)
- Charlotte F. M. Hughes
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gunjan L. Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Barry A. Paul
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC, United States
| |
Collapse
|
2
|
Slade M, Fiala MA, Kirchmeyer M, King J, Gao F, Schroeder MA, Stewart AK, Stockerl-Goldstein K, Chen C, Vij R. Continuous Elotuzumab, Pomalidomide, and Dexamethasone Maintenance Following Second Autologous Transplantation for Multiple Myeloma: Results of a Prospective Phase 2 Multicenter Trial. Transplant Cell Ther 2023; 29:764.e1-764.e7. [PMID: 37741459 DOI: 10.1016/j.jtct.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
Second autologous hematopoietic cell transplantation (AHCT2) is a useful therapeutic modality for fit patients with multiple myeloma who have durable remission after upfront AHCT. Retrospective studies have suggested a significant benefit of incorporating maintenance therapy post-AHCT2, but prospective data on specific regimens are lacking. The purpose of this study was to investigate the use of elotuzumab, pomalidomide, and dexamethasone (EPd) as salvage therapy prior to and maintenance after AHCT2 for relapsed multiple myeloma. This prospective single-arm phase II trial investigating the use of EPd in combination with AHCT2 in patients with relapsed multiple myeloma was conducted at 2 academic centers in North America. The primary outcome was 1-year progression-free survival (PFS). Twenty-five patients were enrolled on the study. Sixteen patients received EPd induction; six patients (38%) progressed during salvage therapy and were removed from the trial prior to AHCT2. Following a planned safety analysis, the protocol was amended, and EPd induction was removed from the study schema. An additional 9 patients underwent induction off-study and were enrolled on trial for AHCT2 and EPd maintenance. A total of 18 patients underwent AHCT2 and received EPd maintenance. Two patients discontinued treatment because of toxicity, one attributed to elotuzumab and the other to pomalidomide. The 1-year PFS was 72%, and the median PFS was 19 months. The study was closed early owing to poor accrual; 6 patients remained on therapy at time of analysis. EPd maintenance after AHCT2 was safe and tolerable. The 1-year PFS and median PFS were similar to values in previous retrospective reports of outcomes following AHCT2. Further studies are needed to define the optimal use of and protocol for AHCT2 in fit patients with relapsed multiple myeloma.
Collapse
Affiliation(s)
- Michael Slade
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
| | - Mark A Fiala
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Marie Kirchmeyer
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jeff King
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Feng Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Mark A Schroeder
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - A Keith Stewart
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Keith Stockerl-Goldstein
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Christine Chen
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ravi Vij
- Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
3
|
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: 0.5] [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.
Collapse
|
4
|
Hernández-Rivas JÁ, Ríos-Tamayo R, Encinas C, Alonso R, Lahuerta JJ. The changing landscape of relapsed and/or refractory multiple myeloma (MM): fundamentals and controversies. Biomark Res 2022; 10:1. [PMID: 35000618 PMCID: PMC8743063 DOI: 10.1186/s40364-021-00344-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/13/2022] Open
Abstract
The increase in the number of therapeutic alternatives for both newly diagnosed and relapsed/refractory multiple myeloma (RRMM) patients has widened the clinical scenario, leading to a level of complexity that no algorithm has been able to cover up to date. At present, this complexity increases due to the wide variety of clinical situations found in MM patients before they reach the status of relapsed/refractory disease. These different backgrounds may include primary refractoriness, early relapse after completion of first-line therapy with latest-generation agents, or very late relapse after chemotherapy or autologous transplantation. It is also important to bear in mind that many patient profiles are not fully represented in the main randomized clinical trials (RCT), and this further complicates treatment decision-making. In RRMM patients, the choice of previously unused drugs and the number and duration of previous therapeutic regimens until progression has a greater impact on treatment efficacy than the adverse biological characteristics of MM itself. In addition to proteasome inhibitors, immunomodulatory drugs, anti-CD38 antibodies and corticosteroids, a new generation of drugs such as XPO inhibitors, BCL-2 inhibitors, new alkylators and, above all, immunotherapy based on conjugated anti-BCMA antibodies and CAR-T cells, have been developed to fight RRMM. This comprehensive review addresses the fundamentals and controversies regarding RRMM, and discusses the main aspects of management and treatment. The basis for the clinical management of RRMM (complexity of clinical scenarios, key factors to consider before choosing an appropriate treatment, or when to treat), the arsenal of new drugs with no cross resistance with previously administered standard first line regimens (main phase 3 clinical trials), the future outlook including the usefulness of abandoned resources, together with the controversies surrounding the clinical management of RRMM patients will be reviewed in detail.
Collapse
Affiliation(s)
| | - Rafael Ríos-Tamayo
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria, Granada, Spain
| | - Cristina Encinas
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rafael Alonso
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan-José Lahuerta
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, Madrid, Spain.
| |
Collapse
|
5
|
Baertsch MA, Fougereau M, Hielscher T, Sauer S, Breitkreutz I, Jordan K, Müller-Tidow C, Goldschmidt H, Raab MS, Hillengass J, Giesen N. Carfilzomib, Lenalidomide, and Dexamethasone Followed by Salvage Autologous Stem Cell Transplant with or without Maintenance for Relapsed or Refractory Multiple Myeloma. Cancers (Basel) 2021; 13:4706. [PMID: 34572934 PMCID: PMC8472377 DOI: 10.3390/cancers13184706] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/05/2022] Open
Abstract
Salvage high-dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) is a treatment option for relapsed and/or refractory multiple myeloma (RRMM). No data are available on salvage HDCT/ASCT following re-induction treatment with state-of-the-art triplet regimens. We retrospectively report on 44 patients receiving salvage HDCT/ASCT following re-induction with carfilzomib/lenalidomide/dexamethasone (KRd). All patients received frontline HDCT/ASCT with median time to progression (TTP1) of 2.9 (1.2-13.5) years, enabling paired comparison of frontline and salvage HDCT/ASCT. After re-induction and before salvage transplant, 25/44 patients (57%) attained ≥ very good partial response (VGPR), which increased to 34/44 (77%) at best response after salvage HDCT/ASCT. Median progression-free survival (PFS) was 23.3 months from salvage HDCT/ASCT. Patients with ≥ VGPR at the time of salvage HDCT/ASCT and those receiving maintenance treatment post salvage HDCT/ASCT had significantly superior PFS (hazard ratio (HR) 0.19, p = 0.001 and HR 0.20, p = 0.009). In patients achieving at least an equal depth of response before salvage HDCT/ASCT as before frontline HDCT/ASCT, PFS after salvage HDCT/ASCT was comparable to the frontline situation (p = 0.3). This is the first report of state-of-the-art triplet re-induction and salvage HDCT/ASCT for RRMM after frontline transplantation. Deep remissions achieved with KRd translate into prolonged PFS following salvage HDCT/ASCT and are enhanced by maintenance treatment.
Collapse
Affiliation(s)
- Marc-Andrea Baertsch
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
| | - Mathilde Fougereau
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center, 69121 Heidelberg, Germany
| | - Sandra Sauer
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
| | - Iris Breitkreutz
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
| | - Karin Jordan
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
| | - Carsten Müller-Tidow
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Hartmut Goldschmidt
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Marc-Steffen Raab
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center, 69121 Heidelberg, Germany
| | - Jens Hillengass
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Nicola Giesen
- Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69121 Heidelberg, Germany
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center, 69121 Heidelberg, Germany
| |
Collapse
|
6
|
Lemieux C, Muffly LS, Iberri DJ, Craig JK, Johnston LJ, Lowsky R, Shiraz P, Rezvani AR, Frank MJ, Weng WK, Meyer E, Shizuru JA, Arai S, Liedtke M, Negrin RS, Miklos DB, Sidana S. Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma. Bone Marrow Transplant 2021; 56:2664-2671. [PMID: 34163014 DOI: 10.1038/s41409-021-01371-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/22/2022]
Abstract
We evaluated the outcomes of 168 patients undergoing delayed or second autologous stem cell transplant (ASCT) for relapsed multiple myeloma (MM) from 2010 to 2019. Overall, 21% (n = 35) patients had received a prior transplant and 69% (n = 116) underwent transplant at first relapse. Overall, 27% patients had high-risk cytogenetics and 15% had ISS stage III disease. Stem cell collection was performed after relapse in 72% and 35% of patients received maintenance therapy. Median PFS from salvage treatment and transplant were 28 and 19 months, respectively. Median OS from salvage treatment and transplant was 69 and 55 months. Multivariate analysis revealed that ASCT in first relapse was associated with superior PFS (HR 0.63, p = 0.03) and OS (HR 0.59, p = 0.04) compared to later lines of therapy. In addition, PFS of ≥36 months with prior therapy was associated with improved PFS (HR 0.62, p = 0.04) and OS (HR 0.41, p = 0.01). Ninety-five patients underwent delayed transplant at first relapse, median PFS and OS from start of therapy was 30 and 69 months, and median OS from diagnosis was 106 months. These data may serve as a guide when counseling patients undergoing ASCT for relapsed MM and provide a benchmark in designing clinical trials of transplantation/comparative treatments for relapsed MM.
Collapse
Affiliation(s)
- Christopher Lemieux
- Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Hematology and Medical Oncology, Department of Medicine, Université Laval, Québec, QC, Canada
| | - Lori S Muffly
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - David J Iberri
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Juliana K Craig
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Robert Lowsky
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Parveen Shiraz
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Matthew J Frank
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Wen-Kai Weng
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Everett Meyer
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Sally Arai
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Robert S Negrin
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - David B Miklos
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Surbhi Sidana
- Department of Medicine, Stanford University, Stanford, CA, USA.
| |
Collapse
|
7
|
[Chinese guidelines of autologous stem cell transplantation for multiple myeloma (2021)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:353-357. [PMID: 34218575 PMCID: PMC8293008 DOI: 10.3760/cma.j.issn.0253-2727.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 11/05/2022]
|
8
|
Malkan UY, Demiroglu H, Buyukasik Y, Karatas A, Aladag E, Goker H. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients. Open Med (Wars) 2021; 16:192-197. [PMID: 33585695 PMCID: PMC7862995 DOI: 10.1515/med-2021-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Autologous stem cell transplantation (ASCT) is one of the standard treatments of choice for eligible multiple myeloma (MM) patients. Herein, we aimed to analyze MM patients at our center and compare the clinical outcomes of single and double ASCT patients. Materials and methods Patients who were diagnosed as having MM and had undergone single or double ASCT in our clinic between the years 2003 and 2020 were retrospectively examined. Results In this study, the median time of second ASCT is approximately 3.6 years from the first ASCT. Overall survival (OS) duration of the single and double transplanted groups was 4,011 ± 266 vs 3,526 ± 326 days, respectively (p: 0.33). Progression-free survival (PFS) duration of the single and double transplanted groups was 2,344 ± 228 vs 685 ± 120 days, respectively (p: 0.22). Disease assessment after ASCT stable or progressive disease, partial remission, and very good partial or complete remission (CR) in single and double ASCT groups was 62/44/105 and 8/4/5, respectively (p: 0.22). Conclusion The present study points out that the second ASCT treatment option for MM patients may not be effective as suggested, especially in the era of novel MM drugs, since our results come from the past data that novel drugs were not exist. In conclusion, we found no benefit with second ASCT in MM patients in terms of PFS and OS or CR rates, and the novel anti-myeloma drugs might decrease the need for a second transplant.
Collapse
Affiliation(s)
- Umit Yavuz Malkan
- Department of Hematology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Haluk Demiroglu
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Yahya Buyukasik
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Ayse Karatas
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Elifcan Aladag
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Hakan Goker
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| |
Collapse
|
9
|
Durer C, Durer S, Lee S, Chakraborty R, Malik MN, Rafae A, Zar MA, Kamal A, Rosko N, Samaras C, Valent J, Chaulagain C, Anwer F. Treatment of relapsed multiple myeloma: Evidence-based recommendations. Blood Rev 2019; 39:100616. [PMID: 31500848 DOI: 10.1016/j.blre.2019.100616] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/14/2019] [Accepted: 08/30/2019] [Indexed: 12/01/2022]
Abstract
The practice of choosing the next best therapy for patients with relapsed and/or refractory multiple myeloma (RRMM) is becoming increasingly complex. There is no clear consensus regarding the best treatment sequence for RRMM. With the approval of novel proteasome inhibitors (ixazomib and carfilzomib), immunomodulatory agents (pomalidomide), monoclonal antibodies (daratumumab and elotuzumab), and other targeted therapies, multiple combination regimens utilizing these agents are being studied with the goal of enhancing disease control, prolonging progression-free survival, and improving overall survival. We, herein, describe a review of FDA-approved regimens for RRMM patients and offer a paradigm in selecting subsequent treatment regimens, focusing on patient specific morbidity, treatment toxicity, and disease-specific characteristics.
Collapse
Affiliation(s)
- Ceren Durer
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Seren Durer
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sarah Lee
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Rajshekhar Chakraborty
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Abdul Rafae
- Department of Medicine, McLaren/Michigan State University, Flint, MI, USA
| | - Muhammad Abu Zar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ahmad Kamal
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nathaniel Rosko
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Christy Samaras
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Valent
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Chakra Chaulagain
- Department of Hematology and Medical Oncology, Cleveland Clinic, Weston, FL, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
10
|
Fiala MA, Vosuri V, Goldsmith S, Schroeder MA, Ghobadi A, Wildes TM, Stockerl-Goldstein KE, Vij R. Maintenance therapy following salvage autologous stem cell transplant in patients with multiple myeloma. Bone Marrow Transplant 2019; 55:1188-1190. [PMID: 31462683 DOI: 10.1038/s41409-019-0663-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mark A Fiala
- Washington University School of Medicine, St Louis, MO, USA
| | - Venkata Vosuri
- Washington University School of Medicine, St Louis, MO, USA
| | | | | | - Armin Ghobadi
- Washington University School of Medicine, St Louis, MO, USA
| | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Ravi Vij
- Washington University School of Medicine, St Louis, MO, USA.
| |
Collapse
|
11
|
Mina R, Lonial S. Is there still a role for stem cell transplantation in multiple myeloma? Cancer 2019; 125:2534-2543. [PMID: 30985927 DOI: 10.1002/cncr.32060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplantation (ASCT) are a standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (MM). The introduction of novel agents, which range from immunomodulatory drugs and proteasome inhibitors to monoclonal antibodies and have now been integrated into both induction and salvage regimens, has dramatically revolutionized the treatment landscape of MM and challenged the role of high-dose chemotherapy and ASCT in treating MM. These advances have led to a number of provocative questions. First, what is the current role of stem cell transplantation (SCT) in comparison with standard-dose therapy incorporating novel agents? Second, should ASCT be performed upfront ("early") or later ("delayed") in the course of the disease? Third, should single or double ASCT be performed? Fourth, is allogeneic SCT still an option for patients with MM? This article provides an overview of available data and evidence-based responses regarding the role of SCT in MM.
Collapse
Affiliation(s)
- Roberto Mina
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sagar Lonial
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| |
Collapse
|
12
|
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: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
|