Efficacy and outcome of autologous transplantation in rare myelomas

Abstract

BackgroundAs rare myelomas, i.e. the IgD, IgE, IgM and non-secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and MethodsWe used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common myelomas (IgG, IgA and light chain myeloma) with the outcome of patients with rare myelomas: 379 IgD, 13 IgE, 72 IgM and 976 non-secretory cases. ResultsThe study confirms the multiple adverse prognostic factors seen in IgD myeloma. Somewhat surprisingly, patients with IgD and non-secretory myeloma both had higher complete remission rates before and after transplantation than patients with common myelomas. However, while the overall survival of patients with non-secretory myeloma was similar to that of the patients with common myelomas, the survival of patients with IgD myeloma was significantly worse (although better than survival rates reported for non-transplanted patients); this was due to higher transplant-related mortality and relapse/progression rates. The post-transplantation survival of patients with IgE or IgM myeloma appears to be very poor. ConclusionsThis study provides data on the biological features of rare myelomas. The overall survival of patients with IgD, IgE or IgM myeloma is poor following autologous transplantation but substantially better than that reported for patients who were not transplanted. Key words: rare myelomas, autologous transplantation, outcome, efficacy. . Haematologica 2010;95(12):2126-2133. doi:10.3324/haematol.2010 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Citation: Morris C, Drake M, Apperley J, Iacobelli S, van Biezen A, Bjorkstrand B, Goldschmidt H, Harousseau J-L, Morgan G, de Witte T, Niederwieser D, and Gahrton G for the Myeloma Subcommittee of the Chronic Leukaemia Working Party of the EBMT. Efficacy and outcome of autologous transplantation in rare myelomas Efficacy and outcome of autologous transplantation in rare myelomas

Efficacy and Survival Outcome Associated with the Use of Novel Agents and Autologous Stem Cell Transplantation in Cases of Immunoglobulin D Multiple Myeloma in Korea

“…In this study, the median overall OS (37.7 months) was remarkably improved, possibly because of the use of novel agents as induction therapy, relative to the median OS (12 months) reported in our previously conducted study [11]; however, these outcomes are still shorter than those reported in studies conducted in Western countries [3, 10, 12, 13, 17, 18]. …”

“…Due to the limitations associated with retrospective analysis, several patients who were treated before 2006, for whom there was no free light chain data in the database and medical records, were evaluated using the European Group for Blood and Marrow Transplantation (EBMT) criteria for response evaluation [10]. The complete response (CR) category was defined as the presence of negative serum and urine immunofixation, the disappearance of any soft tissue plasmacytomas, and the presence of < 5% plasma cells in the bone marrow; our analysis included stringent CR.…”

“…However, it is still not clear whether these therapies improve the prognosis of IgD myeloma when compared with other therapies, and whether the outcomes of ASCT in IgD MM are comparable with those of the more common isotypes of MM. One report suggested that worse outcomes were observed in IgD, IgE, and IgM myelomas after ASCT than in common isotypes of MM [10]. Our previously conducted retrospective study reported poorer outcomes in cases of IgD MM, relative to the other MM isotypes, after ASCT [11].…”

Successful Treatment of Immunoglobulin D Myeloma by Bortezomib and Dexamethasone Therapy

“…Autologous SCT has been established as the first-line therapy for myeloma patients under 65 years old (5). This is the same as IgD myeloma, although the prognosis is poor compared with IgG, and IgA myelomas from the European Group for Blood and Marrow Transplantation Myeloma Database (12). In the present case, her age made her a marginal candidate for first-line autologous SCT; however, she refused a blood transfusion.…”

Therapy for Immunoglobulin D Plasma Cell Myeloma

“…In a study from the Centre for Blood and Marrow Research (CIBMTR) in 36 subjects my colleagues and I found similar outcomes to persons with IgG and IgA plasma cell myeloma [13]. However, another study in 17 subjects reported worse outcomes [14]. …”