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Published on: May 1, 2015
Allogeneic Stem Cell Transplantation in Multiple Myeloma: Risk Factors and Outcomes in the Era of New Therapeutic
Irene Strassl1,2, Alexander Nikoloudis1,2, Sigrid Machherndl-Spandl1,2
1Division of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Department of Internal Medicine I, Ordensklinikum Linz, Fadingerstrasse 1, 4020 Linz, Austria.
Background:
Despite major treatment advances, multiple myeloma remains incurable. The outcome of patients who are refractory to immunomodulatory agents, proteasome inhibitors, and anti-CD38 monoclonal antibodies is poor, and improved treatment strategies for this difficult-to-treat patient population are an unmet medical need.
Methods:
This retrospective, unicentric analysis included 38 patients with relapsed/refractory multiple myeloma or plasma cell leukemia who underwent allogeneic stem cell transplantation (allo-HSCT) between 2013 and 2022. Survival outcomes, relapse incidence, and non-relapse mortality were calculated according to remission status, date of allo-HSCT, cytogenetic risk status, timing, and number of previous autologous HSCTs.
Results:
The median PFS was 13.6 months (95% CI, 7.7-30.4) and the median OS was 51.4 months (95% CI, 23.5-NA) in the overall cohort. The cumulative incidence of relapse at 3 years was 57%, and non-relapse mortality was 16%. The median PFS and OS were significantly longer in patients with very good partial remission (VGPR) or better compared to patients with less than VGPR at the time of allo-HSCT (mPFS 29.7 months (95% CI, 13.7-NA) vs. 6.5 months (95% CI, 2.6-17.0); p = 0.009 and mOS not reached vs. 18.6 months (95% CI, 7.0-NA); p = 0.006).
Conclusion:
For selected patients, allo-HSCT may result in favorable overall survival, in part by providing an appropriate hemato-immunological basis for subsequent therapies.
Insights
Allogeneic stem cell transplantation (allo-HSCT) offers improved survival for selected relapsed/refractory multiple myeloma patients. Achieving very good partial remission before allo-HSCT significantly enhances progression-free and overall survival outcomes.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Multiple myeloma remains incurable despite treatment advances.
- Patients refractory to current therapies face poor outcomes, highlighting an unmet need.
- Novel strategies are crucial for managing relapsed/refractory multiple myeloma.
Purpose of the Study:
- To evaluate the efficacy of allogeneic stem cell transplantation (allo-HSCT) in relapsed/refractory multiple myeloma.
- To analyze survival outcomes, relapse incidence, and non-relapse mortality post-allo-HSCT.
- To identify factors influencing outcomes in patients undergoing allo-HSCT.
Main Methods:
- Retrospective, unicentric analysis of 38 patients with relapsed/refractory multiple myeloma or plasma cell leukemia.
- Patients underwent allo-HSCT between 2013 and 2022.
- Outcomes assessed based on remission status, cytogenetic risk, and prior autologous HSCT history.
Main Results:
- Median progression-free survival (PFS) was 13.6 months; median overall survival (OS) was 51.4 months.
- Three-year cumulative incidence of relapse was 57%; non-relapse mortality was 16%.
- Patients achieving very good partial remission (VGPR) or better showed significantly longer PFS (29.7 vs. 6.5 months) and OS (not reached vs. 18.6 months) compared to those with less than VGPR.
Conclusions:
- Allogeneic stem cell transplantation (allo-HSCT) can lead to favorable overall survival in selected multiple myeloma patients.
- Pre-transplant remission status is a critical factor for successful allo-HSCT outcomes.
- Allo-HSCT may establish a foundation for subsequent therapeutic interventions.
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