Outcomes After Salvage Autologous Hematopoietic Cell Transplant for Patients With Relapsed/Refractory Multiple Myeloma: A Single-Institution Experience |
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| Institution: | 1. Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH;2. Roswell Park Comprehensive Cancer Center, Division of Hematology, Rochester, NY;1. Eppley Institute for Research in Cancer & Allied Diseases and the Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE;2. Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE;3. Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE;4. Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE;1. Department of Oncology, ASST Sette Laghi, Varese, Italy;2. Department of Medicine and Surgery, University of Insubria, Varese, Italy;1. Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Israel;2. Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Israel;1. Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China;2. Beijing University of Chinese Medicine, Beijing, China;3. Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, China |
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| Abstract: | BackgroundThe 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 methodsWe 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.ResultsFifty-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.ConclusionsFor MM patients deriving durable remission after their AHCT1, sAHCT2 was safe and resulted in deep and durable remissions. |
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