TY - JOUR
T1 - Post-Transplant Outcomes in High-Risk Compared with Non–High-Risk Multiple Myeloma
T2 - A CIBMTR Analysis
AU - Scott, Emma C.
AU - Hari, Parameswaran
AU - Sharma, Manish
AU - Le-Rademacher, Jennifer
AU - Huang, Jiaxing
AU - Vogl, Dan
AU - Abidi, Muneer
AU - Beitinjaneh, Amer
AU - Fung, Henry
AU - Ganguly, Siddhartha
AU - Hildebrandt, Gerhard
AU - Holmberg, Leona
AU - Kalaycio, Matt
AU - Kumar, Shaji
AU - Kyle, Robert
AU - Lazarus, Hillard
AU - Lee, Cindy
AU - Maziarz, Richard T.
AU - Meehan, Kenneth
AU - Mikhael, Joseph
AU - Nishihori, Taiga
AU - Ramanathan, Muthalagu
AU - Usmani, Saad
AU - Tay, Jason
AU - Vesole, David
AU - Wirk, Baldeep
AU - Yared, Jean
AU - Savani, Bipin N.
AU - Gasparetto, Cristina
AU - Krishnan, Amrita
AU - Mark, Tomer
AU - Nieto, Yago
AU - D'Souza, Anita
N1 - Publisher Copyright:
© 2016 The American Society for Blood and Marrow Transplantation
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (<45 chromosomes excluding -Y) or chromosome 1 p and 1q abnormalities; all others were non-HRM. Among 125 HRM patients (17.5%), induction with bortezomib and immunomodulatory agents (imids) was higher compared with non-HRM (56% versus 43%, P < .001) with similar pretransplant complete response (CR) rates (14% versus 16%, P .1). At day 100 post-transplant, at least a very good partial response was 59% in HRM and 61% in non-HRM (P = .6). More HRM patients received post-transplant therapy with bortezomib and imids (26% versus 12%, P = .004). Three-year post-transplant progression-free (PFS) and overall survival (OS) rates in HRM versus non-HRM were 37% versus 49% (P < .001) and 72% versus 85% (P < .001), respectively. At 3 years, PFS for HRM patients with and without post-transplant therapy was 46% (95% confidence interval [CI], 33 to 59) versus 14% (95% CI, 4 to 29) and in non-HRM patients with and without post-transplant therapy 55% (95% CI, 49 to 62) versus 39% (95% CI, 32 to 47); rates of OS for HRM patients with and without post-transplant therapy were 81% (95% CI, 70 to 90) versus 48% (95% CI, 30 to 65) compared with 88% (95% CI, 84 to 92) and 79% (95% CI, 73 to 85) in non-HRM patients with and without post-transplant therapy, respectively. Among patients receiving post-transplant therapy, there was no difference in OS between HRM and non-HRM (P = .08). In addition to HRM, higher stage, less than a CR pretransplant, lack of post-transplant therapy, and African American race were associated with worse OS. In conclusion, we show HRM patients achieve similar day 100 post-transplant responses compared with non-HRM patients, but these responses are not sustained. Post-transplant therapy appeared to improve the poor outcomes of HRM.
AB - Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (<45 chromosomes excluding -Y) or chromosome 1 p and 1q abnormalities; all others were non-HRM. Among 125 HRM patients (17.5%), induction with bortezomib and immunomodulatory agents (imids) was higher compared with non-HRM (56% versus 43%, P < .001) with similar pretransplant complete response (CR) rates (14% versus 16%, P .1). At day 100 post-transplant, at least a very good partial response was 59% in HRM and 61% in non-HRM (P = .6). More HRM patients received post-transplant therapy with bortezomib and imids (26% versus 12%, P = .004). Three-year post-transplant progression-free (PFS) and overall survival (OS) rates in HRM versus non-HRM were 37% versus 49% (P < .001) and 72% versus 85% (P < .001), respectively. At 3 years, PFS for HRM patients with and without post-transplant therapy was 46% (95% confidence interval [CI], 33 to 59) versus 14% (95% CI, 4 to 29) and in non-HRM patients with and without post-transplant therapy 55% (95% CI, 49 to 62) versus 39% (95% CI, 32 to 47); rates of OS for HRM patients with and without post-transplant therapy were 81% (95% CI, 70 to 90) versus 48% (95% CI, 30 to 65) compared with 88% (95% CI, 84 to 92) and 79% (95% CI, 73 to 85) in non-HRM patients with and without post-transplant therapy, respectively. Among patients receiving post-transplant therapy, there was no difference in OS between HRM and non-HRM (P = .08). In addition to HRM, higher stage, less than a CR pretransplant, lack of post-transplant therapy, and African American race were associated with worse OS. In conclusion, we show HRM patients achieve similar day 100 post-transplant responses compared with non-HRM patients, but these responses are not sustained. Post-transplant therapy appeared to improve the poor outcomes of HRM.
KW - Autologous HSCT
KW - High risk
KW - Maintenance
KW - Multiple myeloma
UR - http://www.scopus.com/inward/record.url?scp=84992035513&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84992035513&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2016.07.007
DO - 10.1016/j.bbmt.2016.07.007
M3 - Article
C2 - 27496215
AN - SCOPUS:84992035513
SN - 1083-8791
VL - 22
SP - 1893
EP - 1899
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 10
ER -