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Duque-Afonso J, Finke J, Ngoya M, Galimard JE, Craddock C, Raj K, Bloor A, Nicholson E, Eder M, Kim O, Valerius T, Snowden JA, Tholouli E, Crawley C, Collin M, Wilson KMO, Gadisseur A, Protheroe R, Wagner-Drouet EM, Savani BN, Spyridonidis A, Ciceri F, Nagler A, Mohty M. Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 2024; 59:247-254. [PMID: 38040842 PMCID: PMC10849951 DOI: 10.1038/s41409-023-02150-w] [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: 05/30/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m2 (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m2. We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.
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Affiliation(s)
- Jesús Duque-Afonso
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.
| | - Jürgen Finke
- Department of Hematology/Oncology, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Maud Ngoya
- EBMT Statistical Unit, INSERM UMRs 938, Hôpital Saint Antoine, Paris, France
| | | | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Kavita Raj
- Department of Haematology, University College London Hospital, London, UK
| | - Adrian Bloor
- The Christie NHS Foundation Trust, Stem Cell Transplantation Unit, University of Manchester, Manchester, UK
| | - Emma Nicholson
- Department of Haematology, Royal Marsden Hospital, London, UK
| | - Matthias Eder
- Department of Haematology, Hannover Medical School, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Orchard Kim
- Department of Haematology, Southampton General Hospital, Haematology, Oncology & Paediatrics, Southampton, UK
| | - Thomas Valerius
- Department of Medicine II, University Medical Center Schleswig-Holstein, Campus Kiel, Section of Stem Cell Transplantation and Immunotherapy, Kiel, Germany
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Eleni Tholouli
- Clinical Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Charles Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Matthew Collin
- Adult HSCT unit, Northern Centre for Bone Marrow Transplantation, Freeman Hospital, Newcastle Tyne, UK
| | - Keith M O Wilson
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Alain Gadisseur
- Department of Hematology, Antwerp University Hospital (UZA), Antwerp Edegem, Belgium
| | - Rachel Protheroe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Eva Maria Wagner-Drouet
- Department of Hematology, University Medical Center Mainz, Oncology and Pneumology, Mainz, Germany
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Fabio Ciceri
- University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France.
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Jung J, Lee H, Suh YG, Eom HS, Lee E. Current Use of Total Body Irradiation in Haploidentical Allogeneic Hematopoietic Stem Cell Transplantation. J Korean Med Sci 2021; 36:e55. [PMID: 33650334 PMCID: PMC7921367 DOI: 10.3346/jkms.2021.36.e55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/20/2020] [Indexed: 11/20/2022] Open
Abstract
Total body irradiation (TBI) is included in the conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT), with unique advantages such as uniform distribution over the whole body and decreased exposure to cytotoxic chemotherapeutic agents. For individuals who lack matched sibling or matched unrelated donors, the use of haploidentical donors has been increasing despite challenges such as graft rejection and graft-versus-host disease (GVHD). Although a limited number of studies have been performed to assess the clinical role of TBI in haploidentical HSCT, TBI-based conditioning showed comparable results in terms of survival outcomes, rate of relapse, and GVHD in diverse hematologic malignancies such as leukemia, lymphoma, and multiple myeloma. Advances in supportive care, along with recent technical improvements such as restriction of maximum tolerated dose, appropriate fractionation, and organ shielding, help to overcome diverse adverse events related to TBI. Post-transplantation cyclophosphamide was used in most studies to reduce the risk of GVHD. Additionally, it was found that post-transplantation rituximab may improve outcomes in TBI-based haploidentical HSCT, especially in patients with B-cell lymphoma. Along with the advances of techniques and strategies, the expansion of age restriction would be another important issue for TBI-based haploidentical HSCT considering the current tendency toward increasing age limitation and lack of matched donors. This review article summarizes the current use and future perspectives of TBI in haploidentical HSCT.
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Affiliation(s)
- Jongheon Jung
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - Yang Gun Suh
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - Eunyoung Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea.
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Gahrton G, Iacobelli S, Garderet L, Yakoub-Agha I, Schönland S. Allogeneic Transplantation in Multiple Myeloma-Does It Still Have a Place? J Clin Med 2020; 9:E2180. [PMID: 32664274 PMCID: PMC7408931 DOI: 10.3390/jcm9072180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Novel drugs have improved survival for patients with multiple myeloma in recent years. However, the disease is still fatal. Allogeneic stem cell transplantation (Allo) has proven to cure some patients with the disease, but its role is controversial due to relatively high transplant-related toxicity and mortality (nonrelapse mortality, NRM). Using nonmyeloablative reduced-intensity conditioning (RIC), both toxicity and NRM can be reduced, and RICAllo is, therefore, an option for subgroups of patients. Upfront tandem autologous/RICAllo (Auto/RICAllo) was shown to be superior to single Auto or tandem Auto/Auto in both progression-free (PFS) and overall survival (OS) in two prospective studies with long-term follow-up, while three similarly designed studies did not detect a difference. A recent update of pooled patient data from four of these studies showed significantly superior PFS and OS with Auto/RICAllo. Importantly, none of these studies showed inferior results with Auto/RICAllo in patients less than 70 years of age. Auto/RICAllo appears to overcome some poor risk cytogenetic markers. Encouraging results have also been seen in treatment of relapsed patients. Combining Allo with new proteasome inhibitors and immunomodulatory drugs may further improve results. Other encouraging new cell therapies such as with CAR T-cells, NK- and CAR NK-cells may well have a place in combination with RICAllo. Such studies are warranted.
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Affiliation(s)
- Gösta Gahrton
- Department of Medicine, Karolinska Institutet, Huddinge, SE 14186 Stockholm, Sweden
| | - Simona Iacobelli
- Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Laurent Garderet
- Department of Hematology and Cellular Therapy, Hospital Hospital-Pitié Salpêtrière, 75013 Paris, France;
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Université de Lille, INSERM U1286, Infinite, 59000 Lille, France;
| | - Stefan Schönland
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany;
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Thiotepa, Busulfan, and Fludarabine Conditioning Regimen in T Cell-Replete HLA-Haploidentical Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1407-1415. [PMID: 30871978 DOI: 10.1016/j.bbmt.2019.02.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/28/2019] [Indexed: 11/20/2022]
Abstract
We report the outcomes of 51 patients who underwent unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplantation cyclophosphamide (PT-Cy) and antithymocyte globulin (ATG), from peripheral blood stem cells (PBSCs) or bone marrow, after receipt of a TBF (thiotepa, busulfan, and fludarabine) conditioning regimen. Their median age was 55 years (range, 16 to 72 years). Hematologic diagnoses included acute leukemias (n = 31), lymphoid neoplasm (n = 12), myeloproliferative neoplasm (n = 5), and myelodysplastic syndromes (n = 3). Thirty-seven patients (73%) were in complete remission. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and mycophenolate for all patients, associated with ATG in 39 patients (76.5%). The median time to neutrophil engraftment was 17 days (range, 12 to 34 days). The cumulative incidences of grade II-IV and grade III-IV acute GVHD were 27.5% and 14%, respectively. In patients receiving a PBSC graft and ATG prophylaxis, grade II-IV aGVHD occurred in 16% of patients. The use of ATG and a lower thiotepa dose (5 mg/kg versus 10 mg/kg) were associated with a reduced cumulative incidence of grade II-IV acute GVHD (P = .03 and .005, respectively). The 2-year cumulative incidence of chronic GVHD was 29% and was significantly reduced to 13% with the lower thiotepa dose (P = .002). After a median follow-up of 25 months (range, 12 to 62 months), the cumulative incidences of nonrelapse mortality, relapse, overall survival (OS), disease-free survival (DFS), and GVHD-free, relapse-free survival (GFRFS) were 20%, 22.5%, 67%, 58%, and 51%, respectively. Pretransplantation disease status (complete remission versus others) was the main factor associated with OS, DFS, and GFRFS. In conclusion, the TBF conditioning regimen is an appealing platform in the haplo-HSCT setting with PT-Cy in terms of engraftment rate, toxicity, and disease control. We found no benefit of a thiotepa dose of 10 mg/kg compared with a dose of 5 mg/kg. ATG reduced the risk of acute GVHD without comprising outcomes.
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Yin X, Tang L, Fan F, Jiang Q, Sun C, Hu Y. Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017. Cancer Cell Int 2018; 18:62. [PMID: 29713245 PMCID: PMC5913895 DOI: 10.1186/s12935-018-0553-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite recent advances, multiple myeloma (MM) remains incurable. However, the appearance of allogeneic stem cell transplantation (allo-SCT) through graft-versus-myeloma effect provides a potential way to cure MM to some degree. This systematic review aimed to evaluate the outcome of patients receiving allo-SCT and identified a series of prognostic factors that may affect the outcome of allo-SCT. Patients/methods We systematically searched PubMed, Embase, and the Cochrane Library from 2007.01.01 to 2017.05.03 using the keywords ‘allogeneic’ and ‘myeloma’. Results A total of 61 clinical trials involving 8698 adult patients were included. The pooled estimates (95% CI) for overall survival (OS) at 1, 2, 3 and 5 years were 70 (95% CI 56–84%), 62 (95% CI 53–71%), 52 (95% CI 44–61%), and 46 (95% CI 40–52%), respectively; for progression-free survival were 51 (95% CI 38–64%), 40 (95% CI 32–48%), 34 (95% CI 27–41%), and 27 (95% CI 23–31%), respectively; and for treatment-related mortality (TRM) were 18 (95% CI 14–21%), 21 (95% CI 17–25%), 20 (95% CI 13–26%), and 27 (95% CI 21–33%), respectively. Additionally, the pooled 100-day TRM was 12 (95% CI 5–18%). The incidences of grades II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 34 (95% CI 30–37%) and 51 (95% CI 46–56%), respectively. The incidences of relapse rate (RR) and death rate were 50 (95% CI 45–55%) and 51 (95% CI 45–57%), respectively. Importantly, disease progression was the most major cause of death (48%), followed by TRM (44%). The results failed to show an apparent benefit of allo-SCT for standard risk patients, compared with tandem auto-SCT. In contrast, all 14 trials in our study showed that patients with high cytogenetic risk after allo-SCT had similar OS and PFS compared to those with standard risk, suggesting that allo-SCT may overcome the adverse prognosis of high cytogenetic risk. Conclusion Due to the lack of consistent survival benefit, allo-SCT should not be considered as a standard of care for newly diagnosed and relapsed standard-risk MM patients. However, for patients with high-risk MM who have a poor long-term prognosis, allo-SCT may be a strong consideration in their initial course of therapy or in first relapse after chemotherapy, when the risk of disease progression may outweigh the transplant-related risks. A large number of prospective randomized controlled trials were needed to prove the benefits of these therapeutic options. Electronic supplementary material The online version of this article (10.1186/s12935-018-0553-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuejiao Yin
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Liang Tang
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Fengjuan Fan
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Qinyue Jiang
- 2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Chunyan Sun
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
| | - Yu Hu
- 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China.,2Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Jiefang Dadao, Wuhan, 430022 China
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Wu JQ, Zhang SS, Gao H, Qi Z, Zhou CJ, Ji WW, Liu Y, Chen Y, Li Q, Li X, Wang H. Experimental and Theoretical Studies on Rhodium-Catalyzed Coupling of Benzamides with 2,2-Difluorovinyl Tosylate: Diverse Synthesis of Fluorinated Heterocycles. J Am Chem Soc 2017; 139:3537-3545. [DOI: 10.1021/jacs.7b00118] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jia-Qiang Wu
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Shang-Shi Zhang
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Hui Gao
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Zisong Qi
- Dalian
Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China
| | - Chu-Jun Zhou
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Wei-Wei Ji
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yao Liu
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yunyun Chen
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Qingjiang Li
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Xingwei Li
- Dalian
Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China
| | - Honggen Wang
- School
of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
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Abstract
Multiple myeloma is a disorder characterized by accumulation of malignant plasma cells in the bone marrow, hypercalcemia, monoclonal protein, and end organ damage. Recently newer generation proteosome inhibitors, monoclonal antibodies and novel agents have been approved by FDA, which is undoubtedly increasing life expectancy of the patients. However, hematopoietic stem cell transplantation still remains the cornerstone of the treatment. In this chapter, we are discussing the autologous stem cell transplant, allogeneic stem cell transplant and total therapy trials with outcomes.
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Affiliation(s)
- Yogesh S Jethava
- Stem Cell and Allogeneic Transplant, Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Frits van Rhee
- Stem Cell and Allogeneic Transplant, Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
Prospective trials comparing tandem autologous stem cell transplantation (ASCT) with ASCT followed by allogeneic stem cell transplantation (AlloSCT) have shown mixed results with regard to progression-free and overall survival rates. Thus, AlloSCT, although a potentially curative treatment, is not regarded as a standard treatment for multiple myeloma by most experts in the field. Strategies to improve the therapeutic index of the conditioning regimens have the potential to improve outcomes. Other approaches to modulate graft-versus-host disease while preserving or improving a graft-versus-myeloma effect could elevate AlloSCT to mainstream treatment. These approaches include vaccines, monoclonal antibodies, and adoptive immunotherapies.
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Affiliation(s)
- William Bensinger
- Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-390, Seattle, WA 98109, USA.
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9
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Lu J, Huang G, Li HP, Feng KY, Chen L, Zheng MY, Cai YD. Prediction of cancer drugs by chemical-chemical interactions. PLoS One 2014; 9:e87791. [PMID: 24498372 PMCID: PMC3912061 DOI: 10.1371/journal.pone.0087791] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/31/2013] [Indexed: 11/19/2022] Open
Abstract
Cancer, which is a leading cause of death worldwide, places a big burden on health-care system. In this study, an order-prediction model was built to predict a series of cancer drug indications based on chemical-chemical interactions. According to the confidence scores of their interactions, the order from the most likely cancer to the least one was obtained for each query drug. The 1(st) order prediction accuracy of the training dataset was 55.93%, evaluated by Jackknife test, while it was 55.56% and 59.09% on a validation test dataset and an independent test dataset, respectively. The proposed method outperformed a popular method based on molecular descriptors. Moreover, it was verified that some drugs were effective to the 'wrong' predicted indications, indicating that some 'wrong' drug indications were actually correct indications. Encouraged by the promising results, the method may become a useful tool to the prediction of drugs indications.
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Affiliation(s)
- Jing Lu
- Department of Medicinal Chemistry, School of Pharmacy, Yantai University, Yantai, Shandong, People’s Republic of China
| | - Guohua Huang
- Institute of Systems Biology, Shanghai University, Shanghai, People’s Republic of China
- Department of Mathematics, Shaoyang University, Shaoyang, Hunan, People’s Republic of China
| | - Hai-Peng Li
- CAS-MPG Partner Institute for Computational Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Kai-Yan Feng
- Beijing Genomics Institute, Shenzhen Beishan Industrial zone, Shenzhen, People’s Republic of China
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
| | - Ming-Yue Zheng
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
| | - Yu-Dong Cai
- Institute of Systems Biology, Shanghai University, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
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11
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Freytes CO, Vesole DH, LeRademacher J, Zhong X, Gale RP, Kyle RA, Reece DE, Gibson J, Schouten HC, McCarthy PL, Lonial S, Krishnan AY, Dispenzieri A, Hari PN. Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation. Bone Marrow Transplant 2013; 49:416-21. [PMID: 24270389 PMCID: PMC3947725 DOI: 10.1038/bmt.2013.187] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Abstract
There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.
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Affiliation(s)
- C O Freytes
- South Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - D H Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - J LeRademacher
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - X Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R P Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK
| | - R A Kyle
- Mayo Clinic Rochester, Rochester, MN, USA
| | - D E Reece
- Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - J Gibson
- Royal Prince Alfred Hospital Institute of Haematology, Camperdown, Australia
| | - H C Schouten
- Interne Geneeskunde, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | | | - S Lonial
- Emory University Hospital, Atlanta, GA, USA
| | - A Y Krishnan
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - P N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
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12
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Federmann B, Bornhauser M, Meisner C, Kordelas L, Beelen DW, Stuhler G, Stelljes M, Schwerdtfeger R, Christopeit M, Behre G, Faul C, Vogel W, Schumm M, Handgretinger R, Kanz L, Bethge WA. Haploidentical allogeneic hematopoietic cell transplantation in adults using CD3/CD19 depletion and reduced intensity conditioning: a phase II study. Haematologica 2012; 97:1523-31. [PMID: 22491731 DOI: 10.3324/haematol.2011.059378] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We report a prospective multicenter phase II study of haploidentical hematopoietic stem cell transplantation using CD3/CD19-depleted grafts after reduced intensity conditioning with fludarabine, thiotepa, melphalan and OKT-3. DESIGN AND METHODS Sixty-one adults with a median age of 46 years (range 19-65 years) have been enrolled. Diagnoses were acute myeloid leukemia (n=38), acute lymphoblastic leukemia (n=8), non-Hodgkin's lymphoma (n=6), myeloma (n=4), chronic myeloid leukemia (n=3), chronic lymphatic leukemia (n=1) and myelodysplastic syndrome (n=1). Patients were considered high risk because of refractory disease (n=18), cytogenetics (n=6), complete remission (≥ 2) (n=9), chemosensitive relapse in partial remission (n=4) or relapse after prior hematopoietic stem cell transplantation (n=15 allogeneic, n=8 autologous, n=1 both). At haploidentical hematopoietic stem cell transplantation, 30 patients were in complete remission and 31 in partial remission. Grafts contained a median of 7.0 × 10(6) (range 3.2-22) CD34(+) cells/kg, 4.2 × 10(4) (range 0.6-44) CD3(+) T cells/kg and 2.7 × 10(7) (range 0.00-37.3) CD56(+) cells/kg. RESULTS Engraftment was rapid with a median of 12 days to granulocytes more than 0.5 × 10(9)/L (range 9-50 days) and 11 days to platelets more than 20 × 10(9) (range 7-38 days). Incidence of grade IIIV acute graft-versus-host-disease and chronic graft-versus-host-disease was 46% and 18%, respectively. Non-relapse mortality on Day 100 was 23% and 42% at two years. Cumulative incidence of relapse/progression at two years was 31%. Kaplan-Meier estimated 1-year and 2-year overall survival with median follow up of 869 days (range 181-1932) is 41% and 28%, respectively. CONCLUSIONS This regimen allows successful haploidentical hematopoietic stem cell transplantation with reduced intensity conditioning in high-risk patients lacking a suitable donor. (clinicaltrials.gov identifier:NCT00202917).
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Affiliation(s)
- Birgit Federmann
- Medical Center, Department of Hematology & Oncology, University of Tuebingen, Tuebingen, Germany
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Nivison-Smith I, Dodds AJ, Doocey R, Ganly P, Gibson J, Ma DDF, Simpson JM, Szer J, Bradstock KF. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998-2006: factors associated with improved survival outcome. Leuk Lymphoma 2011; 52:1727-35. [PMID: 21864043 DOI: 10.3109/10428194.2011.582201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study reports on the outcome of 95 allogeneic hematopoietic cell transplants (HCTs) using reduced intensity conditioning (RIC) performed for patients with multiple myeloma (MM) in Australia and New Zealand between 1998 and 2006. The median age at HCT was 52 years. Of the 32 patients for whom the allograft was performed as a first transplant, 15 (47%) had their allograft less than 1 year from diagnosis, while for the 63 patients who had an allograft following an autograft, nine (14%) were allografted within 1 year post-diagnosis (p < 0.001). The cumulative incidence of transplant-related mortality (TRM) was 19% at 1 year post-transplant. At 5 years post-transplant the overall survival (OS) was 40% and progression-free survival (PFS) was 23%, with no apparent survival plateau. Three factors were independently favorable predictors of OS in a Cox regression model: immunoglobulin G (IgG) myeloma (hazard ratio [HR] = 0.42, 95% confidence interval [CI] 0.24-0.75, p = 0.004), a human leukocyte antigen (HLA)-identical sibling donor (HR = 0.37, 95% CI 0.18-0.74, p = 0.005), and less than 1 year between MM diagnosis and RIC HCT (HR = 0.27, 95% CI 0.12-0.59, p = 0.001). Patterns of outcome indicate that RIC HCT may offer the potential for cure for only a small group of patients with MM.
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Affiliation(s)
- Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, NSW, Australia.
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Nivison-Smith I, Dodds AJ, Doocey R, Ganly P, Gibson J, Ma DDF, Simpson JM, Szer J, Bradstock KF. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998–2006: factors associated with improved survival outcome. Leuk Lymphoma 2011. [DOI: 10.3109/01443615.2011.582201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lokhorst H, Einsele H, Vesole D, Bruno B, Miguel JS, Pérez-Simon JA, Kröger N, Moreau P, Gahrton G, Gasparetto C, Giralt S, Bensinger W. International Myeloma Working Group Consensus Statement Regarding the Current Status of Allogeneic Stem-Cell Transplantation for Multiple Myeloma. J Clin Oncol 2010; 28:4521-30. [PMID: 20697091 DOI: 10.1200/jco.2010.29.7929] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To define consensus statement regarding allogeneic stem-cell transplantation (Allo-SCT) as a treatment option for multiple myeloma (MM) on behalf of International Myeloma Working Group. Patients and Methods In this review, results from prospective and retrospective studies of Allo-SCT in MM are summarized. Results Although the introduction of reduced-intensity conditioning (RIC) has lowered the high treatment-related mortality associated with myeloablative conditioning, convincing evidence is lacking that Allo-RIC improves the survival compared with autologous stem-cell transplantation. Conclusion New strategies are necessary to make Allo-SCT safer and more effective for patients with MM. Until this is achieved, Allo-RIC in myeloma should only be recommended in the context of clinical trials.
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Affiliation(s)
- Henk Lokhorst
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Hermann Einsele
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - David Vesole
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Benedetto Bruno
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Jesus San Miguel
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Jose A. Pérez-Simon
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Nicolaus Kröger
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Philippe Moreau
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Gosta Gahrton
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Cristina Gasparetto
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - Sergio Giralt
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
| | - William Bensinger
- From the University Hospital Utrecht, the Netherlands; University Hospital Wuerzburg; University Hospital Hamburg-Eppendorf, Germany; The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ; Giovanni Battista Hospital, University of Torino, Torino, Italy; University Hospital of Salamanca, Salamanca, Spain; Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Duke University Hospital, Durham,
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Osman K, Elliott B, Mandeli J, Scigliano E, Malone A, Isola L, Grosskreutz C. Non-myeloablative conditioning and allogeneic transplantation for multiple myeloma. Am J Hematol 2010; 85:249-54. [PMID: 20162541 DOI: 10.1002/ajh.21633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In multiple myeloma (MM), allogeneic stem cell transplantation (alloHCT) carries a lower relapse risk than autologous transplantation but a greater transplant-related mortality. Nonmyeloablative conditioning for allogeneic transplantation (NST) reduces transplant-related toxicity. Results are encouraging when used during first remission in low-risk patients, but less-so in relapsed or refractory disease. This is a single-center retrospective analysis of 20 previously treated MM patients who underwent NST from matched-related or matched-unrelated donors from 2000-2006. Median age was 52.7 years (37.2-68.0). Twenty-five percent had advanced or high-risk disease. Eleven still had active disease prior to NST. Conditioning was total body irradiation 200 cGy on a single fraction on day -5, followed by antithymocyte globulin (ATG) 1.5 mg/kg/day and fludarabine 30 mg/m(2)/day on days -4 to -2. All received immunosuppression, most commonly with oral mycofenylate mofetil and cyclosporine beginning on day -5. At day 100, 50% had achieved complete remission. Transplant-related mortality was 25%. Median overall survival (OS) was 21.2 months (0.6-90+) and progression-free survival (PFS) 6.6 months (0.6-90+). Both OS and PFS were 24% at 3 years. OS was significantly greater for patients with age <52 years (median 27 months vs. 7.9 months, P = 0.031), and there was a trend toward greater OS for those with beta2 microglobulin <2.5 mg/l (median 27 months vs. 7.7 months, P = 0.08). Donor characteristics and Ig type had no significant effect on survival. These data suggest a benefit of NST in relapsed/refractory MM. Randomized trials must be performed to confirm and further qualify this benefit.
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Musto P, D'Auria F. Melphalan: old and new uses of a still master drug for multiple myeloma. Expert Opin Investig Drugs 2007; 16:1467-87. [PMID: 17714032 DOI: 10.1517/13543784.16.9.1467] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The treatment of multiple myeloma has seen significant changes from the initial use of melphalan to the introduction of stem cell transplantation and, most recently, to the era of novel targeted agents. Melphalan still remains as a reference drug for combination regimens, including emerging newer therapeutic options, either used at a standard dose for initial or salvage treatments in patients who are not eligible for more intensive therapies, or in conjunction with new molecules within high-dose chemotherapy programs. In this review, the authors analyze old and novel regimens, including melphalan for the treatment of newly diagnosed or relapsed/resistant patients with multiple myeloma in the clinical settings of standard chemotherapy, as well as autologous or allogeneic stem cell transplantation.
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Affiliation(s)
- Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, CROB, Centro di Riferimento Oncologico di Basilicata, Strada Provinciale, Rionero in Vulture (Pz), Italy.
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