Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time. Leukemia 2018 Apr;32(4):986-995
Date
12/22/2017Pubmed ID
29263438Pubmed Central ID
PMC5871538DOI
10.1038/leu.2017.331Scopus ID
2-s2.0-85044662461 (requires institutional sign-in at Scopus site) 54 CitationsAbstract
Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM) particularly for upfront autologous hematopoietic cell transplant (AHCT) recipients. We hypothesized that new drug classes and combinations employed prior to AHCT as well as after post-AHCT relapse may have changed the natural history of MM in this population. We analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of MM patients receiving single AHCT within 12 months after diagnosis (N=3256) and relapsing early post-AHCT (<24 months), and to identify factors predicting for early vs late relapses (24-48 months post-AHCT). Over three periods (2001-2004, 2005-2008, 2009-2013), patient characteristics were balanced except for lower proportion of Stage III, higher likelihood of one induction therapy with novel triplets and higher rates of planned post-AHCT maintenance over time. The proportion of patients relapsing early was stable over time at 35-38%. Factors reducing risk of early relapse included lower stage, chemosensitivity, transplant after 2008 and post-AHCT maintenance. Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, stage III, >1 line of induction and lack of maintenance. Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time.
Author List
Kumar SK, Dispenzieri A, Fraser R, Mingwei F, Akpek G, Cornell R, Kharfan-Dabaja M, Freytes C, Hashmi S, Hildebrandt G, Holmberg L, Kyle R, Lazarus H, Lee C, Mikhael J, Nishihori T, Tay J, Usmani S, Vesole D, Vij R, Wirk B, Krishnan A, Gasparetto C, Mark T, Nieto Y, Hari P, D'Souza AAuthors
Anita D'Souza MD Associate Professor in the Medicine department at Medical College of WisconsinRaphael Fraser PhD Assistant Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Female
Hematopoietic Stem Cell Transplantation
Humans
Immunoglobulin A
Male
Middle Aged
Multiple Myeloma
Neoplasm Recurrence, Local
Prognosis
Recurrence
Transplantation, Autologous
Young Adult