Salvage second transplantation in relapsed multiple myeloma

Dhakal, Binod; D’Souza, Anita; Kleman, Ariel; Chhabra, Saurabh; Mohan, Meera; Hari, Parameswaran

doi:10.1038/s41375-020-1005-8

Cited by 21 publications

(15 citation statements)

References 15 publications

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“…The phenomenon has also been observed in other studies; for example, in an EBMT study analyzing outcomes after a third auto-HCT performed following previous tandem auto-HCTs, where patients with a longer interval between first-line auto-HCTs and relapse had superior outcomes [21]. Similar correlations have also been seen in other retrospective studies, e.g., [14,15,25,28,30,32,33].…”

Section: Ossupporting

confidence: 79%

“…It is difficult to speculate, how the efficacy of salvage auto-HCT performed with stem cells remobilized after the previous auto-HCT compares with the efficacy of salvage auto-HCT performed with stem cells harvested before the first-line auto-HCT, especially taking into consideration, that for a significant number of studies the information on the type of stem cells used is lacking [21,[27][28][29][30][31][32]. Nevertheless, median PFS of 17 months and median OS of 51 months in our analysis seem to be within the range reported by others for the salvage auto-HCT [11,15,20,25,29,30], including the recent report by CIBMTR with PFS established at 50% at 1 year and 13% at 3 years (vs 65% at 1 year and 26% at 3 years in our study) [32]. Longer time to relapse was associated with survival benefit in terms of both OS and PFS as shown by uni-and multivariable analysis.…”

Section: Osmentioning

confidence: 99%

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Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Drozd‐Sokołowska

Gras

Zinger

et al. 2022

Bone Marrow Transplant

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Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.

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Section: Ossupporting

confidence: 79%

Section: Osmentioning

confidence: 99%

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Drozd‐Sokołowska

Gras

Zinger

et al. 2022

Bone Marrow Transplant

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“…This pattern is associated with active disease in focal lesions or at extramedullary sites, while there is no MM infiltration of random bone marrow, and hence MRD negativity in these patients is not a useful prognostic tool [23]. Furthermore, previous studies have shown shorter PFS after initial transplant as a strong, adverse prognostic marker for PFS and OS after salvage ASCT [14,17,28]. Although we did not have data on PFS after initial ASCT available in this cohort, we show that a shorter time frame from initial ASCT to salvage ASCT predicts for worse outcome after salvage ASCT; however, this was only significant for PFS, which may be due to the limited followup.…”

Section: Discussionmentioning

confidence: 99%

Salvage Autologous Stem Cell Transplantation in Daratumumab-Refractory Multiple Myeloma

Yarlagadda

Gundarlapalli

Parikh

et al. 2021

Cancers

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Daratumumab, a CD38-targeting monoclonal antibody, has significantly improved survival rates in multiple myeloma (MM), yet patients who progress on Daratumumab have dismal clinical outcomes with an overall median of less than 10 months. While emerging novel modalities have shown promising results, the current study explores the use of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in heavily pretreated Daratumumab-refractory MM patients. We retrospectively investigated the outcome of 69 consecutive patients who received upfront ASCT. The median progression-free survival (PFS) for the entire patient cohort was 7.2 months with a median overall survival (OS) of 19.3 months. For patients with ≥very good partial response (VGPR), median PFS and OS improved to 9 months and 34 months, respectively. Achievement of MRD negativity in ≥VGPR did not further improve the outcome. A better performance status, younger age, longer time interval from initial MM diagnosis/initial ASCT to salvage ASCT and low-risk GEP70 were all associated with improved PFS and OS after salvage ASCT. Our results suggest a role for salvage ASCT in selected heavily pretreated and Daratumumab-refractory patients.

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“…Recent retrospective data of the Center for International Blood and Marrow Transplant Research (CIBMTR) strongly indicated a role of salvage ASCT in the novel agent era with a 1-year PFS of 50% and an OS of 94%. It thereby compares favorably with several other approved regimens using newer agents [29]. Another retrospective study performed by the European Blood and Marrow Transplant group (EBMT), showed a median OS of 7 months after the third ASCT if the relapse-free interval (RFI) was <six months, 13 months if the RFI was between 6 and 18 months, and 27 months if the RFI was ≥18 months [30].…”

Section: Treatment Options For MM Patients In Second or Higher Relapsementioning

confidence: 99%

Relapsed/Refractory Multiple Myeloma in 2020/2021 and Beyond

Podar

Leleu

2021

Cancers

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Despite the challenges imposed by the COVID-19 pandemic, exciting therapeutic progress continues to be made in MM. New drug approvals for relapsed/refractory (RR)MM in 2020/2021 include the second CD38 monoclonal antibody, isatuximab, the first BCMA-targeting therapy and first-in-class antibody–drug conjugate (ADC) belantamab mafodotin, the first BCMA-targeting CAR T cell product Idecabtagen-Vicleucel (bb2121, Ide-Cel), the first in-class XPO-1 inhibitor selinexor, as well as the first-in-class anti-tumor peptide-drug conjugate, melflufen. The present introductory article of the Special Issue on “Advances in the Treatment of Relapsed and Refractory Multiple Myeloma: Novel Agents, Immunotherapies and Beyond” summarizes the most recent registration trials and emerging immunotherapies in RRMM, gives an overview on latest insights on MM genomics and on tumor-induced changes within the MM microenvironment, and presents some of the most promising rationally derived future therapeutic strategies.

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Salvage second transplantation in relapsed multiple myeloma

Cited by 21 publications

References 15 publications

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Salvage Autologous Stem Cell Transplantation in Daratumumab-Refractory Multiple Myeloma

Relapsed/Refractory Multiple Myeloma in 2020/2021 and Beyond

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