Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation

C. O. Freytes, D. H. Vesole, Jennifer Le-Rademacher, X. Zhong, R. P. Gale, R. A. Kyle, D. E. Reece, J. Gibson, H. C. Schouten, P. L. McCarthy, S. Lonial, A. Y. Krishnan, Angela Dispenzieri, P. N. Hari

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13% (95% confidence interval (CI), 8-19) vs 2% (95% CI, 1-5, P≤0.001). Three-year PFS and OS for the NST/RIC cohort were 6% (95% CI, 3-10%) and 20% (95% CI, 14-27%). Similar outcomes for the autotransplant cohort were 12% (95% CI, 7-19%, P=0.038) and 46% (95% CI, 37-55%, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95% CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95% CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95% CI, 1.34-2.35) P≤0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.

Original languageEnglish (US)
Pages (from-to)416-421
Number of pages6
JournalBone Marrow Transplantation
Volume49
Issue number3
DOIs
StatePublished - Mar 2014

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Autologous Transplantation
Autografts
Multiple Myeloma
Confidence Intervals
Transplants
Multivariate Analysis
Mortality

Keywords

  • allogeneic
  • multiple myeloma
  • salvage transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation. / Freytes, C. O.; Vesole, D. H.; Le-Rademacher, Jennifer; Zhong, X.; Gale, R. P.; Kyle, R. A.; Reece, D. E.; Gibson, J.; Schouten, H. C.; McCarthy, P. L.; Lonial, S.; Krishnan, A. Y.; Dispenzieri, Angela; Hari, P. N.

In: Bone Marrow Transplantation, Vol. 49, No. 3, 03.2014, p. 416-421.

Research output: Contribution to journalArticle

Freytes, CO, Vesole, DH, Le-Rademacher, J, Zhong, X, Gale, RP, Kyle, RA, Reece, DE, Gibson, J, Schouten, HC, McCarthy, PL, Lonial, S, Krishnan, AY, Dispenzieri, A & Hari, PN 2014, 'Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation', Bone Marrow Transplantation, vol. 49, no. 3, pp. 416-421. https://doi.org/10.1038/bmt.2013.187
Freytes, C. O. ; Vesole, D. H. ; Le-Rademacher, Jennifer ; Zhong, X. ; Gale, R. P. ; Kyle, R. A. ; Reece, D. E. ; Gibson, J. ; Schouten, H. C. ; McCarthy, P. L. ; Lonial, S. ; Krishnan, A. Y. ; Dispenzieri, Angela ; Hari, P. N. / Second transplants for multiple myeloma relapsing after a previous autotransplant-reduced-intensity allogeneic vs autologous transplantation. In: Bone Marrow Transplantation. 2014 ; Vol. 49, No. 3. pp. 416-421.
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abstract = "There is no standard therapy for multiple myeloma relapsing after an autotransplant. We compared the outcomes of a second autotransplant (N=137) with those of an allotransplant (N=152) after non-myeloablative or reduced-intensity conditioning (NST/RIC) in 289 subjects reported to the CIBMTR from 1995 to 2008. NST/RIC recipients were younger (median age 53 vs 56 years; P<0.001) and had a shorter time to progression after their first autotransplant. Non-relapse mortality at 1-year post transplant was higher in the NST/RIC cohort, 13{\%} (95{\%} confidence interval (CI), 8-19) vs 2{\%} (95{\%} CI, 1-5, P≤0.001). Three-year PFS and OS for the NST/RIC cohort were 6{\%} (95{\%} CI, 3-10{\%}) and 20{\%} (95{\%} CI, 14-27{\%}). Similar outcomes for the autotransplant cohort were 12{\%} (95{\%} CI, 7-19{\%}, P=0.038) and 46{\%} (95{\%} CI, 37-55{\%}, P=0.001). In multivariate analyses, risk of death was higher in NST/RIC recipients (hazard ratio (HR) 2.38 (95{\%} CI, 1.79-3.16), P<0.001), those with Karnofsky performance score<90 (HR 1.96 (95{\%} CI, 1.47-2.62), P<0.001) and transplant before 2004 (HR 1.77 (95{\%} CI, 1.34-2.35) P≤0.001). In conclusion, NST/RIC was associated with higher TRM and lower survival than an autotransplant. As disease status was not available for most allotransplant recipients, it is not possible to determine which type of transplant is superior after autotransplant failure.",
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AU - Kyle, R. A.

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