Long-Term Outcomes of Allogeneic Hematopoietic Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma

Authors

Aimaz Afrough
Leonard C Alsfeld
Denái R Milton
Ruby Delgado
Uday R Popat
Yago Nieto
Partow Kebriaei
Betul Oran
Neeraj Saini
Samer Srour
Chitra Hosing
Faisal H Cheema
Sairah Ahmed
Elisabet E Manasanch
Hans C Lee
Gregory P Kaufman
Krina K Patel
Donna M Weber
Robert Z Orlowski
Chelsea C Pinnix
Bouthaina S Dabaja
Sheeba K Thomas
Richard E Champlin
Elizabeth J Shpall
Muzaffar H Qazilbash
Qaiser Bashir

Publication Date

4-1-2023

Journal

Transplantation and Cellular Therapy

DOI

10.1016/j.jtct.2022.05.023

PMID

35605883

Abstract

Despite remarkable progress in survival with the availability of novel agents, an overwhelming majority of patients with multiple myeloma (MM) have disease that relapses. Allogeneic (allo-) hematopoietic cell transplantation (HCT) is a potentially curative option for a subgroup of patients with high-risk MM. This study assessed the long-term outcome of MM patients who underwent allo-HCT while in first remission as consolidation treatment. Thirty-three patients with newly diagnosed MM who underwent allo-HCT as part of consolidation therapy between 1994 and 2016 were reviewed retrospectively. Of these patients, 70% underwent autologous HCT before allo-HCT. All patients were chemosensitive and achieved at least partial response before proceeding to allo-HCT. Most received nonmyeloablative/reduced-intensity conditioning (88%) and a matched sibling donor graft (85%). Acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 30% and 61% of patients, respectively. The median duration of follow-up was 64.1 months (range, 1.4 to 199.2 months) for all patients and 164.4 months (range, 56.0 to 199.2 months) for survivors. The median progression-free survival (PFS) was 36 months (95% confidence interval (CI), 8.6 to 73.0 months). The median time from treatment to progression was 73.0 months (95% CI, 30.6 months to not reached). The median overall survival (OS) was 131.9 months (95% CI, 38.4 months to not reached). Of all patients, 39% were alive for more than 10 years, with 46% (n = 6) without progression or relapse. The cumulative incidence of relapse was 18% at 1 year, 39% at 5 years, and 46% at 10 years post-allo-HCT. The cumulative incidence of nonrelapse mortality was 3% at 100 days, 18% at 1 year, 21% at 3 years, and 24% at 5 year post-allo-HCT. On multivariable analysis, high-risk cytogenetics were associated with a shorter PFS (hazard ratio [HR], 2.7; 95% CI, 1.01 to 7.21; P = .047) and OS (HR, 4.91; 95% CI, 1.48 to 16.27; P = .009). Achieving complete remission after allo-HCT also was associated with longer PFS (HR, 0.24; 95% CI, 0.09 to 0.64; P = .004) and OS (HR, .23; 95% CI, .07 to .72; P = .012). Allo-HCT may confer a survival advantage in a selected population of MM patients when performed early in the disease course; additional data on identifying the patients who will benefit the most are needed.

Keywords

Humans, Multiple Myeloma, Retrospective Studies, Survival Analysis, Neoplasm Recurrence, Local, Hematopoietic Stem Cell Transplantation, Chronic Disease, Graft vs Host Disease, Allogeneic hematopoietic stem cell transplantation, Long-term outcome, Multiple myeloma

Published Open-Access

yes

Recommended Citation

Afrough, Aimaz; Alsfeld, Leonard C; Milton, Denái R; et al., "Long-Term Outcomes of Allogeneic Hematopoietic Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma" (2023). Faculty, Staff and Student Publications. 4920.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4920