Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation

Abstract

Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologousÀallogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was

Multiple Extramedullary-Bone Related and/or Extramedullary Extraosseous Are Independent Poor Prognostic Factors in Patients With Newly Diagnosed Multiple Myeloma

“…37.6 months, P = 0.006). In addition, the data suggested that patients who received dual ASCT had a lower risk of death than patients who received single ASCT (HR: 1.46, P = 0.02) ( 27 ).…”

Current approaches to management of high‐risk multiple myeloma

“…Tandem ASCT, in comparison to single ASCT was especially significant in the HR patients who failed to respond to bortezomib in induction therapy (median PFS 21.0 month and 5‐year estimates 17% after single ASCT vs median PFS 42.0 months and 5‐year estimates 70% after preplanned tandem ASCT) 78 . A recent study by Gagelmann et al in the population of newly diagnosed MM patients with extramedullary disease and HR cytogenetics (del[17p], t[4;14], t[14;16], t[14;20], gain[1q], or del[1p]) demonstrated that tandem ASCT (performed within 12 months) may partially overcome the poor OS (HR, 0.46; 95% CI, 0.24–0.89) 79 . Another support comes from a study by Cavo et al based on EMN02/H095 trial.…”

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“…До «эры новых препаратов» тандемная аутоТГСК увеличивала как ВБП, так и (часто) ОВ, причем в основном за счет пациентов, которые не достигли ≥ охЧР после первой аутоТГСК [29][30][31][32]. В настоящее время польза второй аутоТГСК ограничена пациентами с высоким цитогенетическим риском с t(4;14) и/или del(17p) и не достигшими ПР или лучшего ответа после индукции бортезомибсодержащими программами [33,34]. Вторая трансплантация связана с большей частотой случаев токсической летальности и поэтому может выполняться не во всех трансплантационных центрах [35].…”