Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

Lemieux, Christopher J.; Muffly, Lori; Iberri, David; Craig, Juliana; Johnston, Laura; Lowsky, Robert; Shiraz, Parveen; Rezvani, Andrew R.; Frank, Matthew J.; Weng, Wen‐Kai; Meyer, Everett; Shizuru, Judith A.; Arai, Sally; Liedtke, Michaela; Negrin, Robert S.; Miklos, David B.; Sidana, Surbhi

doi:10.1038/s41409-021-01371-1

Cited by 12 publications

(6 citation statements)

References 45 publications

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“…As in earlier studies of early versus later transplant, no difference in OS (8-year rate: 60.2% vs. 62.2%) was seen between arms [23], suggesting that deferred ASCT as part of the second-line therapy represents a reasonable clinical option. This is supported by several studies demonstrating substantial efficacy with HDM-ASCT in the RRMM setting [14,45,46]. Interestingly, however, in DETERMINATION no difference in OS (5-year rate: 79.2% vs. 80.7%) was seen between RVd alone and RVd + ASCT after a median follow-up of almost 6.5 years [24], despite only 78/279 (28.0%) RVd-alone patients who had discontinued protocol therapy having received subsequent HDM-ASCT.…”

Section: The Challenge Of Comparing Upfront Versus Deferred Hdm-asctmentioning

confidence: 70%

Upfront or Deferred Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Triplet and Quadruplet Induction and Minimal Residual Disease/Risk-Adapted Therapy

Mo,

Hartley-Brown,

Midha

et al. 2023

Cancers

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The standards of care for the initial treatment of patients with newly diagnosed multiple myeloma (NDMM) who are eligible for high-dose melphalan and autologous stem cell transplantation (HDM-ASCT) include highly active triplet and quadruplet regimens based on proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. These regimens are resulting in improved outcomes and increasingly high rates of minimal residual disease (MRD)-negative responses without HDM-ASCT as part of the upfront therapy. Furthermore, recent randomized studies have shown that, while transplant-based approaches as a frontline therapy result in significantly longer progression-free survival compared to non-transplant approaches, this has not translated into an overall survival benefit. Given these developments, and in the context of the treatment burden of undergoing HDM-ASCT, in addition to the acute toxicities and long-term sequelae of HDM, which are associated with the genotoxicity of melphalan, there is an increasing rationale for considering deferring upfront HDM-ASCT in select transplant-eligible patients and saving it as a treatment option for later salvage therapy. Here, we review the latest clinical trial data on upfront or deferred HDM-ASCT and on the activity of quadruplet induction regimens, including rates of MRD-negative responses, and summarize emerging treatment approaches in the upfront setting such as the use of MRD-directed therapy and alternatives to HDM-ASCT.

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Section: The Challenge Of Comparing Upfront Versus Deferred Hdm-asctmentioning

confidence: 70%

Upfront or Deferred Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Triplet and Quadruplet Induction and Minimal Residual Disease/Risk-Adapted Therapy

Mo,

Hartley-Brown,

Midha

et al. 2023

Cancers

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“…In hematological malignancies, HCT is employed for consolidation of disease remission after induction with chemotherapy. In multiple myeloma, indication for a second HCT is limited to patients with upfront tandem autologous transplantation and to patients that have a late relapse in second remission and with a good performance status and limited comorbidities ( 18 , 19 ). In general, a second HCT comes with more complications and increased risk of secondary malignancies and cardiotoxicity due to more exposure to alkylating agents.…”

Section: Discussionmentioning

confidence: 99%

Case report: A successful second autologous hematopoietic stem cell transplantation in refractory systemic sclerosis, with positive effect on skin involvement, pulmonary function and microcirculation

et al. 2022

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BackgroundSystemic sclerosis (SSc) is a complex autoimmune disease characterized by inflammation, vasculopathy and fibrosis of the skin and internal organs. Treatment with autologous hematopoietic cell transplantation (HCT) for progressive SSc has improved overall and event-free survival rates significantly, but unfortunately disease progression after HCT is seen in a subset of patients. Data on the efficacy and safety of second HCT is scarce.CaseWe present a patient with diffuse cutaneous SSc and associated interstitial lung disease (ILD) who successfully underwent a second HCT for progressive disease five years after a first HCT. We describe changes in skin involvement and pulmonary involvement as well as the changes observed in sequential nailfold microcapillaroscopy (NCM), performed from first presentation up to this moment.ConclusionThis case adds to the current limited literature on efficacy and safety of a second HCT in SSc refractory cases. Furthermore it outlines the potential of HCT on amelioration of microvasculopathy in SSc.

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“…Uma opção de tratamento mais importante é a radioterapia percutânea, onde, muitos estudos comprovaram a redução dos sintomas, além da utilização de doses mínimas de radiação, tendo uma percepção de melhora pelos pacientes com MM, além de uma redução no risco de fraturas ósseas. (KLAUS, et al, 2009;ZARGHOONI, et al, 2018;LANG, et al, 2017;SALEMA;CARVALHO, 2019;GENG, et al, 2022;SIVE, et al, 2021, FERVERS, et al, 2021LEUMIEUX, et al, 2021;VIEIRA, et al, 2020).…”

Section: Sinais E Sintomasunclassified

Mieloma múltiplo: indivíduos mais acometidos, seus sintomas, diagnóstico e tratamento: uma análise literária

Rauber¹,

Amâncio²

2023

Braz. J. Hea. Rev.

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O Mieloma Múltiplo (MM) é uma neoplasia maligna, correspondendo a cerca de 10% a 15% das neoplasias existentes, ele consiste basicamente na proliferação neoplásica de plasmócitos na medula óssea, com curso clínico sendo bastante heterogêneo, associado à produção excessiva de paraproteínas monoclonais, o MM é mais comum em pacientes de mais idade, de 40 anos para cima, os sintomas mais comuns são: a preocupação, o estresse, a disfunção sexual e a dor óssea, há também associação com a amiloidose. No diagnóstico é comum a hipercalcemia, a insuficiência renal, a anemia e as lesões ósseas, ele é feito por exames, como o hemograma completo, a ureia, a creatinina, o cálcio, a Reação em Cadeia pela Polimerase (PCR), os exames de imagem também são importantes, além da biópsia, para a confirmação da neoplasia. Há algumas abordagens terapêuticas variadas, com a finalidade de melhorar a qualidade de vida do paciente, o tratamento deve ser individualizado, algumas opções são: os inibidores de proteassoma, os medicamentos imunomoduladores, as quimioterapias e o transplante de medula óssea, porém é uma neoplasia que não possui cura. Trata-se de um artigo de revisão sistemática da literatura, com a finalidade de responder às seguintes questões: “Quais são os indivíduos mais acometidos pelo MM?”, “Como é feito o diagnóstico e o tratamento do MM?” e “Quais os sintomas mais comuns do MM?”, foi feita a inclusão de 20 artigos publicados no ano de 2009 a 2022, encontrados nas seguintes bases de dados: Biblioteca Virtual de Saúde (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine (PubMed), EbscoHost, Google Scholar. O Mieloma Múltiplo ainda é uma doença incurável, porém tratável, o sintoma mais evidente é a dor óssea. Pode-se concluir que para um bom tratamento ser instaurado com mais segurança e uma melhor qualidade de vida, é necessário um diagnóstico precoce.

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Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

Cited by 12 publications

References 45 publications

Upfront or Deferred Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Triplet and Quadruplet Induction and Minimal Residual Disease/Risk-Adapted Therapy

Upfront or Deferred Autologous Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Triplet and Quadruplet Induction and Minimal Residual Disease/Risk-Adapted Therapy

Case report: A successful second autologous hematopoietic stem cell transplantation in refractory systemic sclerosis, with positive effect on skin involvement, pulmonary function and microcirculation

Mieloma múltiplo: indivíduos mais acometidos, seus sintomas, diagnóstico e tratamento: uma análise literária

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