Reduced-intensity conditioning allogeneic SCT as salvage treatment for relapsed multiple myeloma

Abstract

The aim of this retrospective analysis was to assess the benefit of reduced-intensity conditioning allo SCT (RIC allo-SCT) in a cohort of 32 relapsed multiple myeloma (MM) patients. A total of 19 patients had an HLAidentical sibling donor ('donor' group), while 13 patients had no donor ('no-donor' group). There were no significant differences between these two groups as for prognosis risk factors. Eighteen patients from the 'donor' group could actually proceed to RIC allo-SCT. With a median followup of 36 (range, 21-60) months, six patients died from transplant-related toxicity (cumulative incidence, 33% (95% CI, 11-55%)). Only 4 patients from the 18 transplanted patients (22%; 95% CI, 7-48%) progressed after RIC allo-SCT, as compared to 12 (86%; 95% CI, 56-98%; P ¼ 0.0003) among the nontransplanted patients. In an 'intention-to-treat' analysis, the Kaplan-Meier estimate of PFS was significantly higher in the 'donor' group as compared to the 'no-donor' group (P ¼ 0.01; 46 versus 8% at 3 years). There was no difference in terms of overall survival. However, in multivariate analysis, actual performance of RIC allo-SCT was associated with better PFS (relative risk, 0.35; 95% CI, 0.15-0.82; P ¼ 0.01). These data suggest a potential benefit for RIC allo-SCT in the management of relapsed MM warranting further prospective investigations.

Allogenic hematopoietic stem‐cell transplantation with reduced‐intensity conditioning in patients with refractory and recurrent multiple myeloma

“…RIC has reduced the NRM to 10% to 20%. [14][15][16][17][18][19][20][21]24,25 A retrospective large study of the EBMT compared outcome after RIC (320 patients) and myeloablative SCT (196 patients). 16 RIC was found to reduce NRM (24% vs 37%), but this rate was offset by an increase in disease recurrence rates (54% vs 27%), resulting in similar OS.…”

“…NRM was, as may be expected, higher than in the upfront approach, reaching 26%, which is similar to other studies in the same setting. [14][15][16]24,25 With a median follow-up of >6 years, there was a clear plateau in the PFS curve after 3 years, with 34% of patients alive and 26% free of disease progression, 7 years after allogeneic SCT. The EBMT study showed, in a heterogeneous group of 229 patients, similar 3-year OS and PFS rates of 41% and 21%, respectively, with no plateau.…”

“…15 The advantages of allogeneic SCT may only become apparent after a long follow-up, when a plateau becomes apparent, and this study, as well as others in the salvage setting, may not have had sufficient follow-up. 24,25 To the best of our knowledge, the only other study in the salvage setting with a long follow-up was the Seattle auto-allo study published by Rotta et al 17 This study included both upfront and previously treated patients, but not patients with a prior autologous SCT. With a median follow-up of 6.3 years, the OS and PFS rates were 64% and 36%, respectively, with better results for patients treated early (<10 months from the start of initial therapy).…”

“…6,23 Allogeneic SCT has been used in this setting; however, to the best of our knowledge, there are only sparse data regarding the long-term outcome because most studies have a limited follow-up of up to 3 years. [14][15][16]24,25 Longterm data are essential to evaluate the outcome of RIC SCT as a plateau in survival curves may only become apparent years after SCT. In this study, we evaluated the outcome of 50 patients with recurrent/refractory myeloma after RIC SCT.…”

Allo-SCT for multiple myeloma in the era of novel agents: a retrospective study on behalf of Swiss Blood SCT

“…Several authors have performed retrospective analyses with conflicting results. De Lavallade et al 45 and Patriarca et al 29 described two retrospective donor vs no donor analyses, finding a superior PFS for patients with a donor, however, no difference in OS, while Karlin et al 30 recently reported an advantage in OS for allogeneic transplant using a propensity score matching method. Finally, a recent abstract described registry data comparing allogeneic vs autologous transplantation as a second transplant following relapse and found a significantly worse PFS and OS for patients who received an allogeneic transplant, 46 however, the groups were not well balanced.…”