Salvage Second Hematopoietic Cell Transplantation in Myeloma

Laura C. Michaelis, Ayman Saad, Xiaobo Zhong, Jennifer Le-Rademacher, Cesar O. Freytes, David I. Marks, Hillard M. Lazarus, Jennifer M. Bird, Leona Holmberg, Rammurti T. Kamble, Shaji Kumar, Michael Lill, Kenneth R. Meehan, Wael Saber, Jeffrey Schriber, Jason Tay, Dan T. Vogl, Baldeep Wirk, Bipin N. Savani, Robert P. GaleDavid H. Vesole, Gary J. Schiller, Muneer Abidi, Kenneth C. Anderson, Taiga Nishihori, Matt E. Kalaycio, Julie M. Vose, Jan S. Moreb, William Drobyski, Reinhold Munker, Vivek Roy, Armin Ghobadi, H. Kent Holland, Rajneesh Nath, L. Bik To, Angelo Maiolino, Adetola A. Kassim, Sergio A. Giralt, Heather Landau, Harry C. Schouten, Richard T. Maziarz, Joseph Michael, Tamila Kindwall-Keller, Patrick J. Stiff, John Gibson, Sagar Lonial, Amrita Krishnan, Angela Dispenzieri, Parameswaran Hari

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Autologous hematopoietic cell transplantation (AHCT) as initial therapy of patients with multiple myeloma (MM) improves survival. However, data to support this approach for relapsed/progressive disease after initial AHCT (AHCT1) are limited. Using Center for International Blood and Marrow Transplant Research data, we report the outcomes of 187 patients who underwent a second AHCT (AHCT2) for the treatment of relapsed/progressive MM. Planned tandem AHCT was excluded. Median age at AHCT2 was 59 years (range, 28 to 72), and median patient follow-up was 47 months (range, 3 to 97). Nonrelapse mortality after AHCT2 was 2% at 1 year and 4% at 3 years. Median interval from AHCT1 to relapse/progression was 18 months, and median interval between transplantations was 32 months. After AHCT2, the incidence of relapse/progression at 1 and 3 years was 51% and 82%, respectively. At 3 years after AHCT2, progression-free survival was 13%, and overall survival was 46%. In multivariate analyses, those relapsing ≥36 months after AHCT1 had superior progression-free (P = .045) and overall survival (P = .019). Patients who underwent AHCT2 after 2004 had superior survival (P = .026). AHCT2 is safe and feasible for disease progression after AHCT1. In this retrospective study, individuals relapsing ≥36 months from AHCT1 derived greater benefit from AHCT2 compared with those with a shorter disease-free interval. Storage of an adequate graft before AHCT1 will ensure that the option of a second autologous transplantation is retained for patients with relapsed/progressive MM.

Original languageEnglish (US)
Pages (from-to)760-766
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • Multiple myeloma
  • Relapsed multiple myeloma
  • Second autologous transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Michaelis, L. C., Saad, A., Zhong, X., Le-Rademacher, J., Freytes, C. O., Marks, D. I., Lazarus, H. M., Bird, J. M., Holmberg, L., Kamble, R. T., Kumar, S., Lill, M., Meehan, K. R., Saber, W., Schriber, J., Tay, J., Vogl, D. T., Wirk, B., Savani, B. N., ... Hari, P. (2013). Salvage Second Hematopoietic Cell Transplantation in Myeloma. Biology of Blood and Marrow Transplantation, 19(5), 760-766. https://doi.org/10.1016/j.bbmt.2013.01.004