TY - JOUR
T1 - Divergent effects of novel immunomodulatory agents and cyclophosphamide on the risk of engraftment syndrome after autologous peripheral blood stem cell transplantation for multiple myeloma
AU - Cornell, Robert Frank
AU - Hari, Parameswaran
AU - Zhang, Mei Jie
AU - Zhong, Xiabao
AU - Thompson, Jonathan
AU - Fenske, Timothy S.
AU - Horowitz, Mary M.
AU - Komorowski, Richard
AU - Palmer, Jeanne
AU - Pasquini, Marcelo C.
AU - Rizzo, J. Douglas
AU - Saber, Wael
AU - Thomas, Mathew
AU - Drobyski, William R.
PY - 2013/9
Y1 - 2013/9
N2 - Engraftment syndrome (ES) is an increasingly observed and occasionally fatal complication after autologous peripheral blood stem cell transplantation (PBSCT). In this study, we demonstrate that the incidence of ES is significantly increased in patients undergoing autologous PBSCT for multiple myeloma in comparison to patients with non-Hodgkin lymphoma or Hodgkin lymphoma. Multivariate analysis revealed that age > 60 (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12 to 2.62; P= .013) and transplantation for multiple myeloma (HR, 2.80; 95% CI, 1.60 to 4.90; P= .0003) were associated with an increased risk of this complication. When stratified for myeloma patients only, age > 60 (HR, 1.80; 95% CI, 1.13 to 2.87; P= .013) and prior treatment with both lenalidomide and bortezomib (HR, 1.83; 95% CI, 1.11 to 3.04; P= .0001) were associated with an increased incidence of ES. Conversely, lack of exposure to cyclophosphamide from either chemomobilization or as a component of the pretransplantation therapeutic regimen increased the risk of this complication (HR, 3.05; 95% CI, 1.91 to 4.87; P <.0001). These studies demonstrate that the pretransplantation exposure of multiple myeloma patients to novel immunomodulatory agents and cyclophosphamide significantly affects the subsequent risk of developing ES.
AB - Engraftment syndrome (ES) is an increasingly observed and occasionally fatal complication after autologous peripheral blood stem cell transplantation (PBSCT). In this study, we demonstrate that the incidence of ES is significantly increased in patients undergoing autologous PBSCT for multiple myeloma in comparison to patients with non-Hodgkin lymphoma or Hodgkin lymphoma. Multivariate analysis revealed that age > 60 (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12 to 2.62; P= .013) and transplantation for multiple myeloma (HR, 2.80; 95% CI, 1.60 to 4.90; P= .0003) were associated with an increased risk of this complication. When stratified for myeloma patients only, age > 60 (HR, 1.80; 95% CI, 1.13 to 2.87; P= .013) and prior treatment with both lenalidomide and bortezomib (HR, 1.83; 95% CI, 1.11 to 3.04; P= .0001) were associated with an increased incidence of ES. Conversely, lack of exposure to cyclophosphamide from either chemomobilization or as a component of the pretransplantation therapeutic regimen increased the risk of this complication (HR, 3.05; 95% CI, 1.91 to 4.87; P <.0001). These studies demonstrate that the pretransplantation exposure of multiple myeloma patients to novel immunomodulatory agents and cyclophosphamide significantly affects the subsequent risk of developing ES.
KW - Autologous graft-versus-host
KW - Autologous peripheral stem cell
KW - Disease
KW - Engraftment syndrome
KW - Multiple myeloma
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=84882809747&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84882809747&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2013.06.017
DO - 10.1016/j.bbmt.2013.06.017
M3 - Article
C2 - 23806770
AN - SCOPUS:84882809747
SN - 1083-8791
VL - 19
SP - 1368
EP - 1373
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 9
ER -