When to recommend a second autograft in patients with relapsed myeloma?

Ziogas, Dimitrios C.; Terpos, Evangelos; Dimopoulos, Meletios Α.

doi:10.1080/10428194.2016.1246729

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…Another issue to address is the value of the second HSCT. Although the role of second transplantation in relapsed MM remains controversial, 16–18 the six patients who underwent second HSCT in our cohort did very well, with no transplant-related mortality or relapses. This further accentuates the synergistic role of HSCT to triple novel agent-based therapy.…”

Section: Discussionmentioning

confidence: 73%

Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

Byun

Yoon

Koh

et al. 2020

Therapeutic Advances in Hematology

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Background: Traditionally believed to be an integral part of multiple myeloma (MM) treatment, the role of hematopoietic stem-cell transplantation (HSCT) is being challenged. As such, we sought to evaluate the impact of HSCT in the era of novel agents. Methods: A multicenter, retrospective, longitudinal cohort study was carried out between January 2016 and December 2018. A total of 55 patients who received VTD (bortezomib-thalidomide-dexamethasone) as first-line treatment and KRd (carfilzomib-lenalidomide-dexamethasone) as second-line treatment were analyzed for outcomes. Results: The enrolled patients were divided into Group 1, defined as those who continued KRd treatment until progression ( n = 41), versus Group 2, defined as those who underwent HSCT after a certain number of cycles of KRd ( n = 14). Both groups showed a generally favorable response to KRd, with overall response rate (ORR) of 87.9% and clinical benefit rate of 92.8% after a median of seven cycles in Group 1, and ORR 92.8% and clinical benefit rate 100% after median of five cycles in Group 2. However, significantly poorer progression-free survival (PFS) ( p = 0.004) was observed in Group 1 (median 12 months) compared with Group 2 (median not reached). Multivariate analyses identified HSCT after KRd as potential risk factors associated with PFS. Also, in Group 1, bortezomib refractoriness was associated with significantly shorter PFS compared with those who were responsive (median 12 months versus 14 months, respectively, p = 0.039). Conclusions: In conclusion, even with the advent of novel agents, HSCT still remains a valuable treatment modality with additive efficacy.

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Section: Discussionmentioning

confidence: 73%

Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

Byun

Yoon

Koh

et al. 2020

Therapeutic Advances in Hematology

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“…It is standard practice in many centers to collect sufficient cells for more than one transplant [1] for multiple myeloma patients in order to use one aliquot for immediate transplantation and cryopreserve a second aliquot for the possible utilization as a salvage transplant in the future [2]. Patients regularly ask about the quality and integrity of previously collected stem cells.…”

Section: To the Editormentioning

confidence: 99%

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

Gertz

Lacy

Jacob

2020

Bone Marrow Transplant

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“…[1]. Условием для реализации данной опции является длительный безрецидивный интервал после 1й аутоТГСК, который должен быть не менее 18 мес, если никакая дальнейшая терапия не проводи лась, и не менее 36 мес, если пациент получал поддер живающее лечение леналидомидом [2]. Кроме этого, аутоТГСК при рецидиве ММ может быть реализова на у пациентов, не получивших ее по какимто причи нам в 1й линии терапии.…”

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Case report: pomalidomide as maintenance after salvage autologous stem cell transplantation in a patient with relapsed multiple myeloma

Semochkin,

Lunin,

Vernyuk

et al. 2023

Onkogematologiâ

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Currently, lenalidomide is the only immunomodulatory drug (IMiD) approved for maintenance therapy in patients with newly diagnosed multiple myeloma who have received high-dose chemotherapy and autologous stem cell transplantation (ASCT). The maintenance with lenalidomide showed an advantage over placebo or observation for both progression-free and overall survival in a series of phase 3 randomized trials. Salvage ASCT can be performed after disease relapse in case of a long-term response after the first transplantation or if this option has not been performed before. Pomalidomide is a third-generation IMiD approved for the treatment of relapsed and refractory multiple myeloma, which is efficient in patients with resistance to lenalidomide and proteasome inhibitors. Structurally, lenalidomide and pomalidomide are similar, and therefore the latter can also be considered as a drug for maintenance, however, there are no relevant phase 3 randomized trials. In this article, we present a clinical case of a 60-year-old patient with newly diagnosed multiple myeloma who progressed after 2 lines of induction therapy, which included lenalidomide and two proteasome inhibitors (bortezomib, ixazomib). The use of Pd combination (pomalidomide, dexamethasone) made it possible to achieve a repeated response and implement of salvage ASCT. The second ASCT was carried out only 12 months later after the first due to the COVID-19 pandemic. Subsequent long-term maintenance therapy with pomalidomide resulted in a complete response and minimal residual disease negativity. The resulting response has persisted at the time of this writing for over 2 years. To discuss the presented clinical case, the data of the French phase 2 IFM 2013-01 study were used, in which patients with failed first-line transplantation in case of relapse received PCd (pomalidomide, cyclophosphamide, dexamethasone) induction, salvage ASCT, and maintenance by Pd until disease progression. Pomalidomide may be an acceptable substitute for lenalidomide in patients with prior intolerance or refractory to this IMiD.

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When to recommend a second autograft in patients with relapsed myeloma?

Cited by 4 publications

References 40 publications

Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

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

Case report: pomalidomide as maintenance after salvage autologous stem cell transplantation in a patient with relapsed multiple myeloma

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