Long-term outcome after allogeneic stem cell transplantation in multiple myeloma

Abstract

The role of allogeneic hematopoietic stem cell transplantation (allo-SCT) in multiple myeloma is controversial. We analyzed the results of 205 patients transplanted in one center during 2000–2017. Transplantation was performed on 75 patients without a previous autologous SCT (upfront-allo), on 74 as tandem transplant (auto-allo), and on 56 patients after relapse. Median overall survival (OS) was 9.9 years for upfront-allo, 11.2 years for auto-allo, and 3.9 years for the relapse group (p = 0.015). Progression-free survival (PFS) was 2.4, 2.4, and 0.9 years, respectively (p < 0.001). Non-relapse mortality at 5 years was 8% overall, with no significant difference between the groups. Post-relapse survival was 4.1 years for upfront-allo and auto-allo, and 2.6 years for the relapse group (p = 0.066). Survival of high-risk patients was reduced. In multivariate analysis, the auto-allo group had improved OS and chronic graft-versus-host disease was advantageous in terms of PFS, OS, and relapse incidence. Late relapses occurred in all groups. Allo-SCT resulted in long-term survival in a small subgroup of patients. Our results indicate that auto-allo-SCT is feasible and could be considered for younger patients in the upfront setting.

Allogeneic Stem Cell Transplantation in Multiple Myeloma

“…Consistent with the known data for all MM-patients, a higher stage according to ISS or evidence of one of its single factors was associated with impaired survival in various studies [ 52 , 55 , 73 ].…”

“…Due to its substantial therapy-related toxicity, in earlier years, survival after MAC- was inferior as compared to RIC-regimens [ 18 ]. However, a recent pooled data analysis of 61 trials revealed no difference between MAC and RIC [ 51 ], probably due to the improved supportive therapies [ 52 ]. Again, there is a lack of randomized trials comparing different conditioning regimens.…”

“…In line with a suspected higher GvM effect, occurrence of mild or moderate chronic GvHD led to a survival benefit [ 52 , 62 , 67 , 72 , 74 ]. On the contrary, the outcome was worse in patients developing severe acute GvHD, likely due to prolonged immunosuppression and increased TRM [ 52 , 71 , 73 ].…”

Treatment Strategy for Multiple Myeloma to Improve Immunological Environment and Maintain MRD Negativity

“…Two clinical trials have revealed long survival of patients treated with ASCT followed by allogeneic HSCT compared to those treated with tandem ASCT [ 150 , 151 ]. In contrast, a clinical trial on allogeneic HSCT upfront ASCT reported that OS in patients who received allogeneic HSCT was similar to that in patients who received ASCT alone because some patients experienced recurrence and transplant-related mortality after allogeneic transplantation [ 152 ]. Therefore, other immunotherapies are required.…”

Multiple Myeloma Cell-Derived Exosomes: Implications on Tumorigenesis, Diagnosis, Prognosis and Therapeutic Strategies

“…Allogeneic hematopoietic stem cell transplantation (HSCT) is a therapeutic approach that can be evaluated in young subjects with grave MM. Nevertheless, transplant-correlated problems, such as acute and chronic graft-vs-host disease (GVHD) are a significant reason for mortality [ 102 ]. Lia et al performed an experimentation on MM patients subjected to allogeneic HSCT to evaluate exosomal antigens as possible markers for acute GVHD.…”