Trends in Utilization and Outcomes of Autologous Transplantation as Early Therapy for Multiple Myeloma

• Authors: Luciano J. Costa, Medical University of South Carolina; Mei-Jie Zhang, Medical College of Wisconsin; Xiaobo Zhong, Medical College of Wisconsin; Angela Dispenzieri, Mayo Clinic; Sagar Lonial, Emory University; Amrita Krishnan, City of Hope National Medical Center; Cesar Freytes, University of Texas; David Vesole, Hackensack University; Robert Peter Gale, Imperial College; Kenneth Anderson, Dana Farber Cancer Institute; Baldeep Wirk, University of Florida; Edmund Waller, Emory University; Bipin Savani, Vanderbilt University; Harry Schouten, Academische Ziekenhuis Maastricht; Hillard Lazarus, University Hospital Case Medical Center, Cleveland; Kenneth Meehan, Dartmouth Hitchcock Medical Center; Manish Sharma, Fox Chase Cancer Center; Rammurti Kamble, Baylor College of Medicine; Ravi Vij, Barnes Jewish Hospital; Shaji Kumar, Mayo Clinic
• Journal Title: Biology of Blood and Marrow Transplantation
• Volume: Volume 19, Number 11
• Publisher: Elsevier: 12 months | 2013-11-01, Pages 1615-1624
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bbmt.2013.08.002
• Subjects: Health Sciences, Oncology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; Immunology; Transplantation; Multiple myeloma; Autologous stem cell transplantation; Population study; Survival; STEM-CELL TRANSPLANTATION; INTERNATIONAL STAGING SYSTEM; LONG-TERM SURVIVAL; CONSOLIDATION THERAPY; PLUS DEXAMETHASONE; BORTEZOMIB; INDUCTION; THALIDOMIDE; IMPROVEMENT; SUPERIOR

Abstract

The impact of novel drugs for treating multiple myeloma (MM) on the utilization and outcomes of autologous hematopoietic progenitor cell transplantation (AHPCT) is unknown. We reviewed characteristics and outcomes of 20,278 patients who underwent AHPCT within 12months of diagnosis of MM in the United States and Canada and registered at the Center for International Blood and Marrow Transplant Research (CIBMTR) in 3 time cohorts reflecting the increasing availability of novel drugs: 1995 to 1999 (n=2226), 2000 to 2004 (n=6408), and 2005 to 2010 (n=11,644). In the United States, the number of AHPCTs performed increased at a greater rate than new MM cases. Patients in recent cohorts were older, less likely to have stage 3MM, and more likely to have received previous thalidomide, lenalidomide, or bortezomib. On multivariate analysis, AHPCT in the 2000 to 2004 cohort (HR=0.77) or in the 2005 to 2010 cohort (HR=0.68) were associated with lower risk of death. Survival at 60months post-AHPCT improved from 47% in 1995 to 1999 to 55% in 2000 to 2004 and to 57% in 2005 to 2010, owing less to improvement in progression-free survival (50% versus 55% versus 57% at 24months) than to postrelapse/progression survival (58% versus 65% versus 72% at 24months). AHPCT and new biological agents are complementary, nonredundant therapies and should be combined in the management of MM in suitable patients.