Salvage Second Hematopoietic Cell Transplantation in Myeloma

• Type of Material: Article
• Authors: Laura C. Michaelis, Loyola University Medical Center; Ayman Saad, University of Alabama Birmingham; Xiaobo Zhong, Medical College of Wisconsin; Jennifer Le-Rademacher, Medical College of Wisconsin; Cesar O. Freytes, UTHSC Veterans Health Care System; David I. Marks, Bristol Children’s Hospital; Hillard M. Lazarus, University Hospitals of Cleveland; Jennifer M Bird, Bristol Children’s Hospital; Leona Holmberg, Fred Hutchinson Cancer Research Center; Rammurti T. Kamble, Baylor College of Medicine; Shaji Kumar, Mayo Clinic; Michael Lill, Cedars-Sinai Medical Center; Kenneth R. Meehan, Dartmouth Hitchcock Medical Center; Wael Saber, Medical College of Wisconsin; Jeffrey Schriber, City Hope Samaritan; Jason Tay, University of Ottawa; Dan T. Vogl, University of Pennsylvania; Baldeep Wirk, Shands Healthcare; Bipin N. Savani, Vanderbilt University; Sagar Lonial, Emory University
• Language: English
• Date: 2013-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Society for Blood and Marrow Transplantation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2013.01.004
• Title of Journal or Parent Work: Biology of Blood and Marrow Transplantation
• ISSN: 1083-8791
• Volume: 19
• Issue: 5
• Start Page: 760
• End Page: 766
• Grant/Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID) ; a Grant/Cooperative Agreement 5U01HL069294 from NHLBI and NCI ; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS) ; two grants, N00014-06-1-0704 and N00014-08-1-0058, from the Office of Naval Research ; and grants from Allos, Inc. ; Amgen, Inc. ; Angioblast; Anonymous donation to the Medical College of Wisconsin ; Ariad ; Be the Match Foundation ; Blue Cross and Blue Shield Association ; Buchanan Family Foundation ; CaridianBCT ; Celgene Corporation ; CellGenix, GmbH ; Children's Leukemia Research Association ; Fresenius-Biotech North America, Inc. ; Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; Genzyme Corporation ; GlaxoSmithKline ; HistoGenetics, Inc. ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin ; Merck & Co, Inc. ; Millennium: The Takeda Oncology Co. ; Milliman USA, Inc. ; Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; RemedyMD ; Sanofi ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; StemCyte, A Global Cord Blood Therapeutics Co. ; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; Tarix Pharmaceuticals ; Teva Neuroscience, Inc. ; THERAKOS, Inc. ; and Wellpoint, Inc.
• Keywords: AUTOLOGOUS TRANSPLANTATION; BLOOD; Hematology; Science & Technology; Transplantation; Second autologous transplantation; MARROW TRANSPLANTATION; Life Sciences & Biomedicine; CHEMOTHERAPY; Multiple myeloma; Relapsed multiple myeloma; HIGH-DOSE THERAPY; ALLOGENEIC TRANSPLANTATION; RANDOMIZED TRIAL; SINGLE; Immunology; SURVIVAL; DIAGNOSED MULTIPLE-MYELOMA
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

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.