Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft

Abstract

Autologous stem cell transplantation (ASCT) as part of the primary therapy in multiple myeloma (MM) is standard practice. In contrast, the role of a second ASCT (ASCT2) and subsequent lenalidomide maintenance for relapsed disease remains unclear. In this study, we analysed 86 consecutive MM patients with a first relapse after prior ASCT receiving either a second ASCT or conventional chemotherapy. After a median follow-up of 37.7 months since first relapse, 54 (62.8%) patients were still alive and 29 (33.7%) without progression. Sixty-one (71.0%) patients received ASCT2 and had better progression-free survival (PFS) (30.2 versus 13.0 mo; P = .0262) and overall survival (OS) rates (129.6 versus 33.5 mo; P = .0003) compared with 25 (29.0%) patients with conventional treatment. Patients relapsing later than 12 months after ASCT1 benefitted from a second ASCT with better PFS2 (P = .0179) and OS2 (P = .0009). Finally, lenalidomide maintenance after ASCT2 was associated with longer PFS (41.0 vs 21.6 mo; P = .0034) and better OS (not yet reached vs 129.6 mo; P = .0434) compared with patients without maintenance. Our data suggest that a second ASCT and lenalidomide maintenance given at first relapse in MM after prior ASCT are associated with better survival rates.

Salvage second transplantation in relapsed multiple myeloma

“…The depth of response prior to AHCT2 was the only significant factor determining the outcomes in our study and is consistent with several other studies [12][13][14] . The exact agents used for induction regimen were not available in the majority, but our observations underscore the use of effective re-induction strategies to achieve the best possible response in eligible patients for AHCT2.…”

Dose‐intensified bendamustine and melphalan (BenMel) conditioning before second autologous transplantation in myeloma patients

“…Whereas it may be appropriate to use a different conditioning regimen in patients not attaining a CR after HDMel and ASCT1, it may appear questionable to substitute the conditioning regimen in patients attaining a CR after ASCT1, as these patients have demonstrated to be sensitive to HDMel. 42 However, patients in our study typically had cytogenetic high-risk features making them candidates for a more intensive approach, even if this strategy needs prospective confirmation. Finally, it is safe to state that the capacity of the second, different, conditioning regimen to induce CR in patients attaining a suboptimal response after the first procedure is probably crucial to the efficacy of any strategy based on tandem transplants.…”

“…These issues should be taken into account when evaluating safety and efficacy of this new conditioning regimen in myeloma patients. Whereas it may be appropriate to use a different conditioning regimen in patients not attaining a CR after HDMel and ASCT1, it may appear questionable to substitute the conditioning regimen in patients attaining a CR after ASCT1, as these patients have demonstrated to be sensitive to HDMel . However, patients in our study typically had cytogenetic high‐risk features making them candidates for a more intensive approach, even if this strategy needs prospective confirmation.…”

Use of autologous stem cells cryopreserved for over 15 years in stem cell transplantation for multiple myeloma

“…In the four patients we have accurate recovery data, no delay in engraftment was seen. Stem cell transplant is a commonly used therapy, particularly in areas of the globe where access to novel agent therapy is limited due to resource constraints and can result in prolonged survival after a 2nd transplant [6]. The concept of collecting sufficient stem cells for more than one transplant and indefinitely cryopreserving an aliquot for future use is safe and ensures prompt engraftment.…”