We compared post-relapse overall survival (OS) after autologous-allogenenic (auto/allo) versus tandem autologous (auto/auto) hematopoietic cell transplantation (HCT) in multiple myeloma (MM). Post-relapse survival of patients receiving an auto/auto or auto/allo HCT for MM and prospectively reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 2000 and 2010 were analyzed. 404 patients (72.4%) relapsed in the auto/auto group and 178 patients (67.4%) relapsed in the auto/allo group after a median follow up of 8.5 years. Among auto/allo patients, 46% of relapses occurred in < 6 months from 2(nd) HCT, compared to 26% in the auto/auto group. The 6 year post-relapse survival of the auto/allo group (44%) was superior compared to auto/auto group (35%) (p=0.05). 101 patients in auto/allo patients died due to MM (69%) vs. 229 (83%) deaths in auto/auto group. In multivariate analysis, both cohorts had a similar risk of death in the 1st year after relapse (hazard ratio (HR) of 0.72; p=0.12). However, for time points beyond 12 months after relapse, patients in the auto/allo group had superior OS compared with auto/auto cohort (HR for death in auto/auto =1.55; p=0.005). Other factors associated with superior survival were enrollment in a clinical trial for HCT, male sex and novel agent use at induction before HCT. Survival after relapse is superior in auto/allo HCT recipients compared to auto/auto HCT recipients. This likely reflects an improved response to salvage therapy, such as immunomodulatory drugs, potentiated by donor-derived immunologic milieu. Further augmentation of post-allotransplant immune system with new immunotherapies such as monoclonal antibodies, check point inhibitors and others should be studied.
Autologous/Allogeneic Hematopoietic Cell Transplantation (HCT) Versus Tandem Autologous Transplantation for Multiple Myeloma - Comparison of Long Term Post Relapse Survival
Bruno B;
2018-01-01
Abstract
We compared post-relapse overall survival (OS) after autologous-allogenenic (auto/allo) versus tandem autologous (auto/auto) hematopoietic cell transplantation (HCT) in multiple myeloma (MM). Post-relapse survival of patients receiving an auto/auto or auto/allo HCT for MM and prospectively reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 2000 and 2010 were analyzed. 404 patients (72.4%) relapsed in the auto/auto group and 178 patients (67.4%) relapsed in the auto/allo group after a median follow up of 8.5 years. Among auto/allo patients, 46% of relapses occurred in < 6 months from 2(nd) HCT, compared to 26% in the auto/auto group. The 6 year post-relapse survival of the auto/allo group (44%) was superior compared to auto/auto group (35%) (p=0.05). 101 patients in auto/allo patients died due to MM (69%) vs. 229 (83%) deaths in auto/auto group. In multivariate analysis, both cohorts had a similar risk of death in the 1st year after relapse (hazard ratio (HR) of 0.72; p=0.12). However, for time points beyond 12 months after relapse, patients in the auto/allo group had superior OS compared with auto/auto cohort (HR for death in auto/auto =1.55; p=0.005). Other factors associated with superior survival were enrollment in a clinical trial for HCT, male sex and novel agent use at induction before HCT. Survival after relapse is superior in auto/allo HCT recipients compared to auto/auto HCT recipients. This likely reflects an improved response to salvage therapy, such as immunomodulatory drugs, potentiated by donor-derived immunologic milieu. Further augmentation of post-allotransplant immune system with new immunotherapies such as monoclonal antibodies, check point inhibitors and others should be studied.
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