Impact of early relapse after auto-SCT for multiple myeloma

Kumar, Shaji; Mahmood, Shameem; Lacy, Martha Q.; Dispenzieri, Angela; Hayman, Suzanne R.; Buadi, Francis K.; Dingli, David; Rajkumar, S. Vincent; Litzow, Mark R.; Gertz, Morie A.

doi:10.1038/bmt.2008.180

Cited by 88 publications

(84 citation statements)

References 40 publications

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“…[9][10][11][12] A similar observation was seen in our institution where a TTP of o12 months after auto-SCT1 was predictive of shorter OS in a large group of patients irrespective of subsequent therapies given at relapse. 20 It is not surprising that our data demonstrate that patients achieving a CR after their auto-SCT2 tend to benefit the most in terms of duration of response.…”

Section: Discussionmentioning

confidence: 86%

Second auto-SCT for treatment of relapsed multiple myeloma

Gonsalves

Gertz

Lacy

et al. 2012

Bone Marrow Transplant

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High-dose therapy and auto-SCT remain integral in the initial treatment of multiple myeloma (MM), and are increasingly being applied for management of relapsed disease. We examined the outcomes in 98 patients undergoing salvage auto-SCT (auto-SCT2) for relapsed MM after receiving an initial transplant (auto-SCT1) between 1994 and 2009. The median age at auto-SCT2 was 60 years (range: 35-74). The median time between auto-SCT1 and auto-SCT2 was 46 months (range: 10-130). Treatment-related mortality was seen in 4%. The median PFS from auto-SCT2 was 10.3 (95% confidence interval (CI): 7-14) months and the median OS from auto-SCT2 was 33 months (95% CI: 28-51). In a multivariable analysis, shorter time to progression (TTP) after auto-SCT1, not achieving a CR after auto-SCT2, higher number of treatment regimens before auto-SCT2 and a higher plasma cell labeling index at auto-SCT2 predicted for shorter PFS. However, only a shorter TTP after auto-SCT1 predicted for a shorter OS post auto-SCT2. Hence, auto-SCT2 is an effective and feasible therapeutic option for MM patients relapsing after other treatments, especially in patients who had a TTP of at least 12 months after their auto-SCT1.

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Section: Discussionmentioning

confidence: 86%

Second auto-SCT for treatment of relapsed multiple myeloma

Gonsalves

Gertz

Lacy

et al. 2012

Bone Marrow Transplant

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“…6,12,16,17 Although auto-SCT after NAs induction can result in sustained responses in the majority of cases, still there are some patients relapsing within a year after auto-SCT and this group has poorly been characterized. 5 In this study, we presented our data on ER for patients undergoing single auto-SCT who received NAs induction chemotherapy at our institution in a period of 10 years. The median survival for the whole group was 93 months showing a great benefit associated with the introduction of NAs.…”

Section: Discussionmentioning

confidence: 99%

“…Other prognostic markers such as plasma cell labeling index and circulating plasma cells at stem cell collection have been reported as predictors of ER by the Mayo Clinic group in the setting of conventional chemotherapy. 5 Unfortunately, the plasma cell labeling index is not widely used due to the technical difficulties that make it less appealing to employ. We did not look for circulating plasma cells at the time of stem cell collection but this is something that should be interrogated in the era of NAs, as patients exposed to these drugs are deemed to have deeper responses than those treated with conventional chemotherapy in the past.…”

Section: Overall Survival and β2mmentioning

confidence: 99%

“…5 For patients who undergo SCT, one of the most important factors to determine survival is the duration of remission post auto-SCT and o 12 months was selected, based on previous publications on this issue. 5,6 End points…”

Section: Definition Of Ermentioning

confidence: 99%

“…3 Although auto-SCT can result in sustained responses in a large group of patients,~20% of the patients relapse within a year from auto-SCT. 4 Kumar et al, 5 reported a multivariate analysis in a group of 494 patients treated mostly with conventional chemotherapy induction followed by auto-SCT showing that only an elevated plasma cell labeling index (41%) at transplant, more than one treatment regimen prior to auto-SCT, and failure to achieve a CR were predictive of relapse within 12 months of auto-SCT. 5 No association with abnormal cytogenetics was found in the multivariate analysis even in the small group of patients assessed by FISH.…”

Section: Introductionmentioning

confidence: 99%

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Early relapse after single auto-SCT for multiple myeloma is a major predictor of survival in the era of novel agents

Jiménez-Zepeda

Reece

Trudel

et al. 2014

Bone Marrow Transplant

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The role of auto-SCT in the treatment of multiple myeloma (MM) in the era of novel agents continues to evolve. It is now clear that the depth of response and clinical outcomes have significantly improved as a result of the combination of these strategies. However, not all patients with MM who undergo auto-SCT are able to sustain a meaningful response and 20% of patients relapse shortly after auto-SCT. In this study, we aimed to assess the impact of early relapse (ER) after auto-SCT on OS for MM patients undergoing single auto-SCT who had received novel agent-based induction regimens. All consecutive patients with MM undergoing single auto-SCT from January 2002 to September 2012 who had novel induction therapy were evaluated. A total of 184 patients were identified. The median OS and PFS for the group of transplanted patients were 93 and 25.4 months, respectively. Median time to relapse was 17.2 months with 40% having relapsed at the time of analysis. ER (o 12 months post auto-SCT) was seen in 27 (36%) out of 75 patients who had relapsed, and median OS was significantly shorter than in those with non-ER. Multivariate analysis showed ER as the major independent prognostic factor for OS. On the basis of these findings, we conclude that not only attainment of a good response, but sustainability of it, appears to be a major prognostic variable in MM in the era of novel therapy. Patients with ER post auto-SCT should biologically be characterized in prospective studies to better understand the mechanisms of resistance associated with this particular entity.

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Plasma Cell Disorders

Yee¹,

Hideshima²,

Raje³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview Plasma cell disorders have in common a proliferation of monoclonal plasma cells associated with the production of a monoclonal protein. These disorders range from the common, indolent condition of monoclonal gammopathy of undetermined significance to malignancies such as multiple myeloma characterized by the presence of hypercalcemia, anemia, renal dysfunction, and/or lytic bone lesions. Progress in the understanding of the molecular underpinnings of myeloma has led to remarkable advances in its treatment. High‐dose melphalan and autologous stem cell transplant have been a mainstay of treatment. Now, highly effective and well‐tolerated drug classes such as the proteasome inhibitors (e.g., bortezomib, carfilzomib), immunomodulatory drugs (e.g., lenalidomide, pomalidomide), and anti‐CD38 monoclonal antibodies (e.g., daratumumab, isatuximab) have rapidly transformed treatment and significantly improved overall survival. Newer therapies targeting B‐cell maturation antigen (BCMA) have the potential to further improve outcomes.

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Impact of early relapse after auto-SCT for multiple myeloma

Cited by 88 publications

References 40 publications

Second auto-SCT for treatment of relapsed multiple myeloma

Second auto-SCT for treatment of relapsed multiple myeloma

Early relapse after single auto-SCT for multiple myeloma is a major predictor of survival in the era of novel agents

Plasma Cell Disorders

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