American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma

• Type of Material: Conference Paper
• Authors: Sagar Lonial, Emory University; Sergio Giralt, Memorial Sloan Kettering Cancer Center; Laurent Garderet, Hospital St Antoine; Brian Durie, International Myeloma Foundation; Gordon Cook, St. James University Hospital; Gosta Gahrton, Karolinska Institute; Benedetto Bruno, Universita Degli Studi di Torini; Paremesweran Hari, Medical College of Wisconsin; Henk Lokhorst, University Medical Center Utrecht; Phillip McCarthy, Roswell Park Cancer Institute; A Krishnan, City of Hope Cancer Center Duarte; P Sonneveld, Erasmus Medical Center; H Goldschmidt, University of Heidelberg; S Jagannath, Mount Sinai School of Medicine; B Barlogie, Mount Sinai School of Medicine; M Mateos, Hospital Universitario de Salamanca; P Gimsing, Rigshospitalet; O Sezer, Memorial Sisli Hastanesi; J Mikhael, Mayo Clinic Scottsdale; J Lu, Peking University; M Dimopoulos, University of Athens; A Mazumder, New York University; A Palumbo, University of Torino; R Abonour, Indiana University; K Anderson, Harvard University; M Attal, Institut Claudius Regaud; J Blade, IDIBAPS; J Bird, University Hospital Bristol; M Cavo, University of Bologna; R Comenzo, Tufts University; J de la Rubia, Hospital Dr. Pesse; H Einsele, Klinik der Universität Würzburg; R Garcia-Sanz, Hosp Univ Salamanca; J Hillengass, Heidelberg Univ; S Holstein, Roswell Pk Canc Inst; HE Johnsen, Aalborg Univ Hosp; D Joshua, University of Sydney; G Koehne, Mem Sloan Kettering Canc Ctr; S Kumar, Mayo Clin Rochester; R Kyle, Mayo Clin Rochester; X Leleu, Hosp Claude Huriez; H Ludwig, Wilhelminenkrebsforsch Inst; H Nahi, Karolinska Institutet; A Nooka, Emory University; R Orlowski, Univ Texas MD Anderson Canc Ctr; V Rajkumar, Mayo Clin Rochester; A Reiman, Dalhousie University; P Richardson, Harvard University; E Riva, Hosp Clin Montevideo; JS Miguel, Univ Navarra Clin; I Turreson, Skane University Hospital; S Usmani, Levine Canc Inst; D Vesole, John Theurer Canc Ctr; W Bensinger, Fred Hutchinson Canc Res Ctr; M Qazilbash, Univ Texas MD Anderson Canc Ctr; Y Efebera, Ohio State University; M Mohty, Univ Paris 06; C Gasparreto, Duke Univ Hosp; J Gajewski, Oregon Hlth & Sci Univ; CF LeMaistre, Sarah Cannon Res Inst; C Bredeson, Ottawa Hospital Research Institute; P Moreau, Univ Hosp Nantes; M Pasquini, Medical College of Wisconsin; N Kroeger, Univ Hamburg Hosp; E Stadtmauer, University of Pennsylvania
• Language: English
• Date: 2015-12-01
• Publisher: Emory University Libraries
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2015.09.016
• Title of Journal or Parent Work: Biology of Blood and marrow Transplantation
• Conference or Event Name: International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma
• Volume: 21
• Issue: 12
• Start Page: 2039
• End Page: 2051
• Grant/Funding Information: Blood and Marrow Transplant Clinical Trials Network U10HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute U10HL069294) and by the Be The Match Foundation (Grant # U10HL069294, and an Unrestricted educational grant to the International Myeloma Foundation from SANOFI Corporation.
• Keywords: BORTEZOMIB-THALIDOMIDE-DEXAMETHASONE; PROGRESSION; Salvage therapy; AUTOLOGOUS TRANSPLANTATION; COMBINATION THERAPY; FOLLOW-UP; LENALIDOMIDE PLUS DEXAMETHASONE; MAINTENANCE; Hematology; Transplantation; Science & Technology; Stem cell transplantation; Myeloma; Immunology; ALLOGENEIC TRANSPLANTATION; LOW-DOSE DEXAMETHASONE; RANDOMIZED PHASE-III; Life Sciences & Biomedicine
• Research Categories: Health Sciences, General; Health Sciences, Oncology

Abstract

In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.