Salvage Second Hematopoietic Cell Transplantation in Myeloma Journal Article

Authors: Michaelis, L. C.; Saad, A; Zhong, X.; Le-Rademacher, J.; Freytes, C. O.; Marks, D. I.; Lazarus, H. M.; Bird, J. M.; Holmberg, L; Kamble, R. T.; Kumar, S; Lill, M; Meehan, K. R.; Saber, W; Schriber, J.; Tay, J.; Vogl, D. T.; Wirk, B; Savani, B. N.; Gale, R. P.; Vesole, D. H.; Schiller, G. J.; Abidi, M; Anderson, K. C.; Nishihori, T; Kalaycio, M. E.; Vose, J. M.; Moreb, J. S.; Drobyski, W.; Munker, R; Roy, V.; Ghobadi, A; Holland, H. K.; Nath, R; To, L. B.; Maiolino, A; Kassim, A. A.; Giralt, S. A.; Landau, H.; Schouten, H. C.; Maziarz, R. T.; Michael, J.; Kindwall-Keller, T; Stiff, P. J.; Gibson, J; Lonial, S.; Krishnan, A; Dispenzieri, A; Hari, P; Plasma Cell Disorders Working Committee of the Center for International Blood and Marrow Transplant Research
Article Title: Salvage Second Hematopoietic Cell Transplantation in Myeloma
Abstract: Autologous hematopoietic cell transplantation (AHCT) as initial therapy of patients with multiple myeloma (MM) improves survival. However, data to support this approach for relapsed/progressive disease after initial AHCT (AHCT1) are limited. Using Center for International Blood and Marrow Transplant Research data, we report the outcomes of 187 patients who underwent a second AHCT (AHCT2) for the treatment of relapsed/progressive MM. Planned tandem AHCT was excluded. Median age at AHCT2 was 59 years (range, 28 to 72), and median patient follow-up was 47 months (range, 3 to 97). Nonrelapse mortality after AHCT2 was 2% at 1 year and 4% at 3 years. Median interval from AHCT1 to relapse/progression was 18 months, and median interval between transplantations was 32 months. After AHCT2, the incidence of relapse/progression at 1 and 3 years was 51% and 82%, respectively. At 3 years after AHCT2, progression-free survival was 13%, and overall survival was 46%. In multivariate analyses, those relapsing >/=36 months after AHCT1 had superior progression-free (P = .045) and overall survival (P = .019). Patients who underwent AHCT2 after 2004 had superior survival (P = .026). AHCT2 is safe and feasible for disease progression after AHCT1. In this retrospective study, individuals relapsing >/=36 months from AHCT1 derived greater benefit from AHCT2 compared with those with a shorter disease-free interval. Storage of an adequate graft before AHCT1 will ensure that the option of a second autologous transplantation is retained for patients with relapsed/progressive MM.
Journal Title: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume: 19
Issue: 5
ISSN: 1523-6536; 1083-8791
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2013
Start Page: 760
End Page: 766
Language: eng
Notes: ID: 13086; CI: Copyright (c) 2013; JID: 9600628; 2012/08/28 [received]; 2013/01/02 [accepted]; 2013/01/05 [aheadofprint]; ppublish