Hematopoietic cell transplantation utilization and outcomes for primary plasma cell leukemia in the current era

Binod Dhakal, Sagar Patel, Saulius Girnius, Lohith Bachegowda, Raphael Fraser, Omar Davila, Abraham S. Kanate, Amer Assal, Amr Hanbali, Asad Bashey, Attaphol Pawarode, César O. Freytes, Cindy Lee, David Vesole, Robert Frank Cornell, Gerhard C. Hildebrandt, Hemant S. Murthy, Hillard M. Lazarus, Jan Cerny, Jean A. YaredJeffrey Schriber, Jesus Berdeja, Keith Stockerl-Goldstein, Kenneth Meehan, Leona Holmberg, Melhem Solh, Miguel Angel Diaz, Mohamed A. Kharfan-Dabaja, Nosha Farhadfar, Qaiser Bashir, Reinhold Munker, Richard F. Olsson, Robert P. Gale, Ruthlee Lu Bayer, Sachiko Seo, Saurabh Chhabra, Shahrukh Hashmi, Sherif M. Badawy, Taiga Nishihori, Wilson Gonsalves, Yago Nieto, Yvonne Efebera, Shaji Kumar, Nina Shah, Muzaffar Qazilbash, Parameswaran Hari, Anita D’Souza

Research output: Contribution to journalArticle

Abstract

The outcomes of patients with primary plasma cell leukemia (pPCL) after undergoing hematopoietic cell transplantation (HCT) in the novel agent era are unknown. We report outcomes of 348 patients with pPCL receiving autologous (auto-) HCT (n = 277) and allogeneic (allo-) HCT (n = 71) between 2008 and 2015. Median age was 60 years and 56 years for auto- and allo-HCT respectively. For auto-HCT, the 4-year outcomes were: non-relapse mortality (NRM) 7% (4–11%), relapse (REL) 76% (69–82%), progression-free survival (PFS) 17% (13–23%), and overall survival (OS) 28% (22–35%). Karnofsky performance status (KPS) > 90 and ≥very good partial response (VGPR) predicted superior OS in multi-variate analysis for auto-HCT. For allo-HCT, the 4-year outcomes were: NRM 12% (5–21%), REL 69% (56–81%), PFS 19% (10–31%), and OS 31% (19–44%). Compared with prior CIBMTR pPCL patients (1995–2006), inferior survival was noted in the current cohort (3-year OS, 39% vs. 38% in allo-HCT, and 62% vs. 35% in auto-HCT) respectively. However, we noted an increased HCT utilization, from 12% (7–21%) in 1995 to 46% (34–64%) in 2009 using SEER data (available till 2009). Despite modern induction translating to higher proportion receiving HCT, the outcomes remain poor in pPCL patients, mainly derived by high relapse rates post-HCT.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Dhakal, B., Patel, S., Girnius, S., Bachegowda, L., Fraser, R., Davila, O., Kanate, A. S., Assal, A., Hanbali, A., Bashey, A., Pawarode, A., Freytes, C. O., Lee, C., Vesole, D., Cornell, R. F., Hildebrandt, G. C., Murthy, H. S., Lazarus, H. M., Cerny, J., ... D’Souza, A. (Accepted/In press). Hematopoietic cell transplantation utilization and outcomes for primary plasma cell leukemia in the current era. Leukemia. https://doi.org/10.1038/s41375-020-0830-0